Plasma and dietary vitamin C levels and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST).
Vitamin C is an antioxidant and inhibitor of carcinogenic N-nitroso compound production in the stomach. Higher dietary vitamin C consumption is associated with decreased risk of gastric cancer (GC) in numerous case-control studies, but data from prospective studies are limited, particularly so for blood measures of vitamin C. The objective of this study was to determine the association of plasma and dietary vitamin C levels with the risk of GC in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), a large cohort involving 10 European countries. Using a fluorometric method, vitamin C was measured in pre-diagnostic plasma from 215 GC cases (matched controls = 416). Conditional logistic regression models adjusted by body mass index, total energy intake, smoking status/duration/intensity and Helicobacter pylori infection status were used to estimate relative cancer risks. No association with GC risk was observed for dietary vitamin C, whereas an inverse GC risk was observed in the highest versus lowest quartile of plasma vitamin C [odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.31-0.97, P(trend) = 0.043], which was maintained after exclusion of cases with <or=2 years follow-up (OR = 0.40, 95% CI = 0.19-0.83, P(trend) = 0.064). The inverse association was more pronounced in subjects consuming higher levels of red and processed meats, a factor that may increase endogenous N-nitroso compound production. The effect of plasma vitamin C was not different by GC anatomical subsite (cardia/non-cardia) or histological subtype (diffuse/intestinal), and there was no significant interaction of effect with H.pylori. The results of this study show, in a prospective setting, an inverse association of GC risk with high levels of plasma vitamin C and suggest an interaction with the intake of red and processed meats, whose consumption may elevate endogenous N-nitroso compound production.
Jenab
Mazda
M
Nutrition and Hormones Group, IARC-WHO Lyon, France.
Riboli
Elio
E
Ferrari
Pietro
P
Sabate
Joan
J
Slimani
Nadia
N
Norat
Teresa
T
Friesen
Marlin
M
Tjønneland
Anne
A
Olsen
Anja
A
Overvad
Kim
K
Boutron-Ruault
Marie-Christine
MC
Clavel-Chapelon
Françoise
F
Touvier
Mathilde
M
Boeing
Heiner
H
Schulz
Mandy
M
Linseisen
Jakob
J
Nagel
Gabriele
G
Trichopoulou
Antonia
A
Naska
Androniki
A
Oikonomou
Eleni
E
Krogh
Vittorio
V
Panico
Salvatore
S
Masala
Giovanna
G
Sacerdote
Carlotta
C
Tumino
Rosario
R
Peeters
Petra H
PH
Numans
Mattijs E
ME
Bueno-de-Mesquita
Hendrik B
HB
Büchner
Frederike L
FL
Lund
Eiliv
E
Pera
Guillem
G
Sanchez
Carmen Navarro
CN
Sánchez
Maria-José
MJ
Arriola
Larraitz
L
Barricarte
Aurelio
A
Quirós
José Ramón
JR
Hallmans
Göran
G
Stenling
Roger
R
Berglund
Göran
G
Bingham
Sheila
S
Khaw
Kay-Tee
KT
Key
Timothy
T
Allen
Naomi
N
Carneiro
Fatima
F
Mahlke
U
U
Del Giudice
Guiseppe
G
Palli
Domenico
D
Kaaks
Rudolf
R
Gonzalez
Carlos A
CA
D000368:Aged; D001205:Ascorbic Acid / Q000097:blood*; D016022:Case-Control Studies; D015331:Cohort Studies; D019587:Dietary Supplements; D005060:Europe; D005260:Female; D016480:Helicobacter pylori / Q000378:metabolism; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000382:microbiology
D001205:Ascorbic Acid