Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC).
BACKGROUND
Dietary factors are thought to have an important role in gastric and esophageal carcinogenesis, but evidence from cohort studies for such a role is lacking. We examined the risks of gastric cancer and esophageal adenocarcinoma associated with meat consumption within the European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort.


METHODS
A total of 521,457 men and women aged 35-70 years in 10 European countries participated in the EPIC cohort. Dietary and lifestyle information was collected at recruitment. Cox proportional hazard models were used to examine associations between meat intake and risks of cardia and gastric non-cardia cancers and esophageal adenocarcinoma. Data from a calibration substudy were used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. In a nested case-control study, we examined interactions between Helicobacter pylori infection status (i.e., plasma H. pylori antibodies) and meat intakes. All statistical tests were two-sided.


RESULTS
During a mean follow-up of 6.5 years, 330 gastric adenocarcinoma and 65 esophageal adenocarcinomas were diagnosed. Gastric non-cardia cancer risk was statistically significantly associated with intakes of total meat (calibrated HR per 100-g/day increase = 3.52; 95% CI = 1.96 to 6.34), red meat (calibrated HR per 50-g/day increase = 1.73; 95% CI = 1.03 to 2.88), and processed meat (calibrated HR per 50-g/day increase = 2.45; 95% CI = 1.43 to 4.21). The association between the risk of gastric non-cardia cancer and total meat intake was especially large in H. pylori-infected subjects (odds ratio per 100-g/day increase = 5.32; 95% CI = 2.10 to 13.4). Intakes of total, red, or processed meat were not associated with the risk of gastric cardia cancer. A positive but non-statistically significant association was observed between esophageal adenocarcinoma cancer risk and total and processed meat intake in the calibrated model. In this study population, the absolute risk of development of gastric adenocarcinoma within 10 years for a study subject aged 60 years was 0.26% for the lowest quartile of total meat intake and 0.33% for the highest quartile of total meat intake.


CONCLUSIONS
Total, red, and processed meat intakes were associated with an increased risk of gastric non-cardia cancer, especially in H. pylori antibody-positive subjects, but not with cardia gastric cancer.
González
Carlos A
CA
Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain. cagonzalez@ico.scs.es
Jakszyn
Paula
P
Pera
Guillem
G
Agudo
Antonio
A
Bingham
Sheila
S
Palli
Domenico
D
Ferrari
Pietro
P
Boeing
Heiner
H
del Giudice
Giuseppe
G
Plebani
Mario
M
Carneiro
Fátima
F
Nesi
Gabriella
G
Berrino
Franco
F
Sacerdote
Carlotta
C
Tumino
Rosario
R
Panico
Salvatore
S
Berglund
Göran
G
Simán
Henrik
H
Nyrén
Olof
O
Hallmans
Göran
G
Martinez
Carmen
C
Dorronsoro
Miren
M
Barricarte
Aurelio
A
Navarro
Carmen
C
Quirós
José R
JR
Allen
Naomi
N
Key
Timothy J
TJ
Day
Nicholas E
NE
Linseisen
Jakob
J
Nagel
Gabriele
G
Bergmann
Manuela M
MM
Overvad
Kim
K
Jensen
Majken K
MK
Tjonneland
Anne
A
Olsen
Anja
A
Bueno-de-Mesquita
H Bas
HB
Ocke
Marga
M
Peeters
Petra H M
PH
Numans
Mattijs E
ME
Clavel-Chapelon
Françoise
F
Boutron-Ruault
Marie-Christine
MC
Trichopoulou
Antonia
A
Psaltopoulou
Theodora
T
Roukos
Dimitrios
D
Lund
Eiliv
E
Hemon
Bertrand
B
Kaaks
Rudolf
R
Norat
Teresa
T
Riboli
Elio
E
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D000328:Adult; D000368:Aged; D002299:Cardia; D016022:Case-Control Studies; D016001:Confidence Intervals; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008460:Meat; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D011795:Surveys and Questionnaires