Cross-sectional study with multiple measurements of biological markers for assessing stomach cancer risks at the population level.

A cross-sectional study to determine correlations between measurable biologic markers and mortality from stomach cancer was performed in various areas of Japan. Blood and urine were collected from randomly selected 40- to 49-year-old men and their spouses in four areas with different rates of mortality from stomach cancer. The samples were analyzed for levels of the micronutrients vitamins A, C, and E, beta-carotene, and lycopene in plasma and for levels of NaCl, nitrate, and N-nitrosamino acids (N-nitrosoproline, N-nitrosothioproline [NTPRO] and N-nitrosomethylthioproline [NMTPRO]) in 24-hr urine. A significant, strong correlation was found between the amount of salt excreted in urine and stomach cancer mortality in both men and women. Although the amounts of nitrate and of the three N-nitrosamino acids in 24-hr urine were not correlated with stomach cancer rates, the low excretion levels of NTPRO and NMTPRO in the lowest risk area for stomach cancer were noteworthy, regardless of the high level of nitrate excretion in the same area. This suggests a lesser degree of endogenous nitrosation in the body. No protective effect of micronutrients was observed in this correlation study; there was, however, a negative correlation between plasma lycopene level and stomach cancer mortality. Salt intake was thus confirmed to play an important role in the development of stomach cancer and is likely to be a rate-regulating factor in Japanese populations. N-Nitrosamino acids and lycopene may also be related to stomach cancer mortality.