Shu-Jun Liu1, Pi-Di Huang1, Jia-Min Xu1, Qian Li2,3, Jian-Hui Xie2,3, Wen-Zhen Wu2,3, Chen-Tong Wang4, Xiao-Bo Yang5,6. 1. School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China. 2. State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 36, Yuexiu District, Guangzhou, 510000, Guangdong, People's Republic of China. 3. Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. 4. The First Clinical Medical College, Heilongjiang University of Traditional Chinese Medicine, Harbin, China. 5. State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 36, Yuexiu District, Guangzhou, 510000, Guangdong, People's Republic of China. yangxiaobo621@126.com. 6. Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. yangxiaobo621@126.com.
Abstract
BACKGROUND: Several systematic reviews and meta-analyses evaluated the associations between dietary factors and the incidence of gastric cancer (GC). OBJECTIVES: To evaluate the strength and validity of existing evidence, we conducted an umbrella review of published systematic reviews and meta-analyses that investigated the association between diets and GC incidence. METHODS: We searched the PubMed, Embase, and Cochrane databases for systematic reviews and meta-analyses of prospective cohort studies investigating the association between dietary factors and GC risk. For each association, we recalculated the adjusted summary estimates with their 95% confidence interval (CI) and 95% prediction interval (PI) using a random-effects model. We used the I2 statistic and Egger's test to assess heterogeneity and small-study effects, respectively. We also assessed the methodological quality of each study and the quality of evidence. RESULTS: Finally, we identified 16 meta-analyses that described 57 associations in this umbrella review. Of the 57 associations, eight were statistically significant using random-effects, thirteen demonstrated substantial heterogeneity between studies (I2 > 50%), and three found small-study effects. The methodological quality of meta-analyses was classified as critically low for two (13%), low for thirteen (81%), and only one (6%) was rated as high confidence. Quality of evidence was rated high for a positive association for GC incidence with a higher intake of total alcohol (RR = 1.19, 95% CI 1.06-1.34) and moderate-quality evidence to support that increased processed meat consumption can increase GC incidence. Three associations (total fruit, vitamin E, and carotenoids) were determined to be supported by low-quality evidence, and two (pickled vegetables/foods and citrus fruit) were supported by very low-quality. CONCLUSIONS: Our findings support the dietary recommendations for preventative GC, emphasizing lower intake of alcohol and foods preserved by salting. New evidence suggests a possible role for total fruit, citrus fruit, carotenoids, and vitamin E. More research is needed on diets with lower quality evidence. REGISTRATION NUMBER: CRD42021255115.
BACKGROUND: Several systematic reviews and meta-analyses evaluated the associations between dietary factors and the incidence of gastric cancer (GC). OBJECTIVES: To evaluate the strength and validity of existing evidence, we conducted an umbrella review of published systematic reviews and meta-analyses that investigated the association between diets and GC incidence. METHODS: We searched the PubMed, Embase, and Cochrane databases for systematic reviews and meta-analyses of prospective cohort studies investigating the association between dietary factors and GC risk. For each association, we recalculated the adjusted summary estimates with their 95% confidence interval (CI) and 95% prediction interval (PI) using a random-effects model. We used the I2 statistic and Egger's test to assess heterogeneity and small-study effects, respectively. We also assessed the methodological quality of each study and the quality of evidence. RESULTS: Finally, we identified 16 meta-analyses that described 57 associations in this umbrella review. Of the 57 associations, eight were statistically significant using random-effects, thirteen demonstrated substantial heterogeneity between studies (I2 > 50%), and three found small-study effects. The methodological quality of meta-analyses was classified as critically low for two (13%), low for thirteen (81%), and only one (6%) was rated as high confidence. Quality of evidence was rated high for a positive association for GC incidence with a higher intake of total alcohol (RR = 1.19, 95% CI 1.06-1.34) and moderate-quality evidence to support that increased processed meat consumption can increase GC incidence. Three associations (total fruit, vitamin E, and carotenoids) were determined to be supported by low-quality evidence, and two (pickled vegetables/foods and citrus fruit) were supported by very low-quality. CONCLUSIONS: Our findings support the dietary recommendations for preventative GC, emphasizing lower intake of alcohol and foods preserved by salting. New evidence suggests a possible role for total fruit, citrus fruit, carotenoids, and vitamin E. More research is needed on diets with lower quality evidence. REGISTRATION NUMBER: CRD42021255115.
Authors: Sarah Carman; Farin Kamangar; Neal D Freedman; Margaret E Wright; Sanford M Dawsey; L Beth Dixon; Amy Subar; Arthur Schatzkin; Christian C Abnet Journal: Int J Cancer Date: 2009-07-01 Impact factor: 7.396
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