title: Impact of serum total cholesterol on the incidence of gastric cancer in a population-based prospective study: the Hisayama study.
abstract: The results of prospective studies that have examined the association between serum cholesterol levels and the incidence of gastric cancer remain controversial. To examine this issue in a general population, a total of 2,604 subjects aged 40 years or older were followed up prospectively for 14 years. During the follow-up period, gastric cancer developed in 97 subjects. The age- and sex-adjusted incidence of gastric cancer by quartiles of serum cholesterol level, namely, <4.06, 4.06-5.32, 5.33-6.04 and >or=6.05 mmol/L, were 3.9, 3.3, 3.1 and 2.1 per 1,000 person-years, respectively. The risk of gastric cancer increased with decreasing cholesterol level (age- and sex-adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.01-1.49; p = 0.04 for a decrease of 1 mmol/L in serum cholesterol level). This inverse association remained unchanged even after adjustment for other confounding factors, namely, Helicobacter pylori infection, atrophic gastritis, family history of malignant neoplasm, smoking habits, body mass index, hemoglobin A1c, white blood cell count and dietary factors (adjusted HR, 1.28; 95% CI, 1.03-1.58; p = 0.02). This association was significant for intestinal-type gastric cancers, but not for diffuse-type. As regards cancer stage, the inverse cholesterol-cancer association was marginally significant for early gastric cancer after multivariate-adjustment (adjusted HR, 1.25; 95% CI, 0.97-1.61; p = 0.09), but was not for advanced gastric cancer probably due to the small number of cases. In conclusion, our findings suggest that low serum cholesterol levels are an independent risk factor for developing gastric cancer, especially intestinal-type gastric cancer.
authors.affiliation: Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. k-asano@intmed2.med.kyushu-u.ac.jp
authors.forename: Kouichi
authors.initials: K
authors.lastname: Asano
authors.forename: Michiaki
authors.initials: M
authors.lastname: Kubo
authors.forename: Koji
authors.initials: K
authors.lastname: Yonemoto
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Doi
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Yumihiro
authors.initials: Y
authors.lastname: Tanizaki
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Tomoko
authors.initials: T
authors.lastname: Shirota
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D007414:Intestinal Neoplasms / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology*
chemical_list: D002784:Cholesterol