title: Composite protective lifestyle factors and risk of developing gastric adenocarcinoma: the Singapore Chinese Health Study.
abstract: BACKGROUND
  Incidence of gastric cancer is the highest in Eastern Asia. Multiple modifiable lifestyle factors have been identified as risk factors for gastric cancer. However, their aggregated effect on the risk of gastric cancer has not been examined among populations with high prevalence of Helicobacter pylori.
  
  
  METHODS
  A study was conducted to examine the association between multiple lifestyle factors together and the risk of developing gastric adenocarcinoma in the Singapore Chinese Health Study, a prospective cohort of 63 257 men and women between 45 and 74 years enroled during 1993-1998. Composite score of cigarette smoking, alcohol consumption, obesity, dietary pattern, and sodium intake at baseline was assessed with hazard ratio (HR) and 95% confidence interval (CI) of gastric adenocarcinoma using Cox regression method.
  
  
  RESULTS
  Higher healthy composite lifestyle scores were significantly associated with reduced risk of gastric adenocarcinoma in a dose-dependent manner. Hazard ratios (95% CIs) for total, cardia, and non-cardia gastric adenocarcinoma for the highest (score 5) vs lowest composite score (score 0/1/2) were 0.42 (0.31-0.57), 0.22 (0.10-0.47), and 0.55 (0.39-0.78), respectively (all Ptrend<0.001). These lifestyles together accounted for 48% of total gastric adenocarcinoma cases in the study population. The inverse association was observed in both genders, and remained after exclusion of first 5 years of follow-up.
  
  
  CONCLUSIONS
  The inverse association between the aggregated healthy lifestyle factors and the risk of gastric adenocarcinoma is in dose-dependent manner in this highly H. pylori-exposed population. These lifestyle factors together may account for up to half of disease burden in this study population.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.
authors.forename: Zhensheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.|Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
authors.affiliation: National Registry of Diseases Office, Health Promotion Board, 3 Second Hospital Avenue, Level 5, Singapore 168937, Singapore.
authors.forename: Aizhen
authors.initials: A
authors.lastname: Jin
authors.affiliation: Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, UPMC Cancer Pavilion, Suite 4C, 5150 Centre Avenue, Pittsburgh, PA 15232, USA.
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA.|Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, UPMC Cancer Pavilion, Suite 4C, 5150 Centre Avenue, Pittsburgh, PA 15232, USA.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013274:Stomach Neoplasms / Q000453:epidemiology*