Ethnicity and H. pylori as risk factors for gastric cancer in Malaysia: A prospective case control study.
OBJECTIVE
To determine the risk factors for gastric cancer (GCA), with particular emphasis on ethnicity in our multiracial population.


METHODS
A prospective case control study with ratio of cancer:controls of 1:2. Diagnosis of H. pylori was made by serology using the ELISA technique. Dietary intake was assessed by dietary recall over the preceding 6 months.


RESULTS
Eighty-seven cases of GCA were enrolled. The cancers were predominantly distal in location and of the intestinal type. Risk factors identified following multiple logistic regression analysis were: Chinese race (OR 10.23 [2.87-36.47]), H. pylori (OR 2.54 [1.16-5.58]), low level of education (OR 9.81 [2.03-47.46]), smoking (OR 2.52 [1.23-5.15]), and high intake of salted fish and vegetables (OR 5.18 [1.35-20.00]) were identified as significant independent risk factors for GCA, while high intake of fresh fruits and vegetables was protective for GCA (OR 0.15 [0.04-0.64]). Chili intake was not a significant protective factor following multivariate analysis.


CONCLUSIONS
Chinese race was a strong independent predictor of GCA. H. pylori was an important predictor of GCA with a 2.5-fold greater risk in our patients. Despite a high prevalence of H. pylori, the prevalence of GCA among Indians was low and this paradox can be appropriately called the "Indian enigma."
Goh
Khean-Lee
KL
Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Cheah
Phaik-Leng
PL
Md
Noorfaridah
N
Quek
Kia-Fatt
KF
Parasakthi
Navaratnam
N
D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002681:China / Q000208:ethnology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D007194:India / Q000208:ethnology; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000382:microbiology*