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Int J Cancer. 2018 Dec 6. doi: 10.1002/ijc.32046. [Epub ahead of print]

Citrus fruit intake and gastric cancer: The stomach cancer pooling (StoP) project consortium.

Author information

1
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
2
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
3
Harbin Medical University, Harbin, China.
4
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.
5
Mexico National Institute of Public Health, Morelos, Mexico.
6
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
7
EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
8
Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
9
Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia.
10
CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
11
Department of Public Health, Miguel Hernandez University, FISABIO-ISABIAL, Alicante, Spain.
12
Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.
13
Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom.
14
Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA.
15
Dirección General de Planeación y Desarrollo en Salud, Secretaría de Salud. Coyoacán 1501, Ciudad de México, Mexico.
16
Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
17
Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
18
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
19
Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson, Comprehensive Cancer Center, CA, Los Angeles, USA.
20
Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.
21
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
22
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
23
Department of Public and Community Health, School of Health Sciences, University of West Attica, Egaleo, Greece.
24
The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
25
Università Cattolica del Sacro Cuore, Sezione di Igiene, Istituto di Sanità Pubblica, Rome, Italy.
26
Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Igiene Ospedaliera, Rome, Italia.
27
Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.

Abstract

Diets rich in vegetables and fruit have been associated with reduced risk of gastric cancer, and there is suggestive evidence that citrus fruits have a protective role. Our study aimed at evaluating and quantifying the association between citrus fruit intake and gastric cancer risk. We conducted a one-stage pooled analysis including 6,340 cases and 14,490 controls from 15 case-control studies from the stomach cancer pooling (StoP) project consortium. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer across study-specific tertiles of citrus fruit intake (grams/week) were estimated by generalized linear mixed effect models, with logistic link function and random intercept for each study. The models were adjusted for sex, age, and the main recognized risk factors for gastric cancer. Compared to the first third of the distribution, the adjusted pooled OR (95% CI) for the highest third was 0.80 (0.73-0.87). The favourable effect of citrus fruits increased progressively until three servings/week and leveled off thereafter. The magnitude of the association was similar between cancer sub-sites and histotypes. The analysis by geographic area showed no association in studies from the Americas. Our data confirm an inverse association between citrus fruits and gastric cancer and provide precise estimates of the magnitude of the association. However, the null association found in studies from America and in some previous cohort studies prevent to draw definite conclusions on a protective effect of citrus fruit consumption.

KEYWORDS:

case-control studies; citrus fruits; gastric cancer; pooled analysis

PMID:
30521095
DOI:
10.1002/ijc.32046

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