Table 3.
Pooled odds ratio of gastric cancer for the highest vs. the lowest study-specific tertile of fruits, non-citrus fruits, vegetables, and fruits and vegetables consumption (portions/day) according to strata of selected variables.
| Fruits | Non-citrus fruits | Vegetables | Fruits and vegetables | |||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI)a | I2 (%) | OR (95% CI)a | I2 (%) | OR (95% CI)a | I2 (%) | OR (95% CI)a | I2 (%) | |
| Overall | 0.76 (0.64–0.90) | 59.7 | 0.86 (0.73–1.02) | 55.0 | 0.68 (0.56–0.84) | 74.5 | 0.61 (0.49–0.75) | 75.5 |
| Sex | ||||||||
| Men | 0.74 (0.57–0.95) | 67.9 | 0.76 (0.59–0.97) | 63.3 | 0.72 (0.57–0.91) | 67.7 | 0.62 (0.48–0.80) | 72.7 |
| Women | 0.75 (0.60–0.94) | 31.4 | 0.94 (0.68–1.30) | 60.9 | 0.66 (0.51–0.86) | 46.6 | 0.59 (0.45–0.78) | 55.3 |
| p for interaction | 0.938 | 0.308 | 0.627 | 0.796 | ||||
| Age (years) | ||||||||
| ≤55 | 0.83 (0.66–1.05) | 18.4 | 0.92 (0.76–1.12) | 0.0 | 0.72 (0.55–0.95) | 46.0 | 0.67 (0.52–0.86) | 32.1 |
| >55 to ≤65 | 0.65 (0.48–0.88) | 44.6 | 0.83 (0.59–1.15) | 51.0 | 0.82 (0.57–1.19) | 67.6 | 0.60 (0.41–0.88) | 70.5 |
| >65 | 0.79 (0.63–0.99) | 39.9 | 0.89 (0.71–1.11) | 34.9 | 0.67 (0.54–0.84) | 40.2 | 0.65 (0.53–0.80) | 37.5 |
| p for interaction | 0.438 | 0.871 | 0.650 | 0.894 | ||||
| Area | ||||||||
| Europe | 0.79 (0.64–0.98) | 60.5 | 0.94 (0.76–1.16) | 57.6 | 0.61 (0.46–0.80) | 76.3 | 0.59 (0.46–0.76) | 72.5 |
| Asia | 0.73 (0.49–1.09) | 18.45.6 | 0.69 (0.40–1.19) | 63.7 | 0.99 (0.65–1.51) | 66.5 | 0.75 (0.59–0.95) | 0.0 |
| Americas | 0.69 (0.44–1.08) | 65.2 | 0.80 (0.55–1.18) | 38.4 | 0.62 (0.44–0.89) | 52.0 | 0.53 (0.28–0.98) | 84.3 |
| p for interaction | 0.843 | 0.502 | 0.142 | 0.310 | ||||
| Socioeconomic status b | ||||||||
| Low | 0.66 (0.52–0.84) | 56.9 | 0.72 (0.56–0.93) | 54.6 | 0.66 (0.50–0.88) | 70.0 | 0.59 (0.46–0.75) | 64.1 |
| Intermediate | 0.96 (0.75–1.23) | 26.9 | 1.06 (0.81–1.38) | 36.0 | 0.79 (0.62–1.00) | 31.4 | 0.75 (0.56–0.99) | 54.7 |
| High | 0.95 (0.60–1.51) | 32.1 | 1.14 (0.78–1.66) | 19.9 | 0.63 (0.36–1.11) | 50.2 | 0.75 (0.49–1.17) | 41.7 |
| p for interaction | 0.079 | 0.052 | 0.561 | 0.387 | ||||
| Cigarette smoking c | ||||||||
| Never | 0.75 (0.61–0.91) | 34.7 | 0.90 (0.70–1.15) | 48.4 | 0.69 (0.54–0.88) | 56.7 | 0.60 (0.47–0.78) | 62.5 |
| Former | 0.86 (0.62–1.19) | 48.6 | 0.96 (0.69–1.36) | 49.6 | 0.72 (0.54–0.98) | 37.9 | 0.60 (0.44–0.81) | 48.6 |
| Current | 0.63 (0.46–0.86) | 36.1 | 0.60 (0.42–0.86) | 45.5 | 0.78 (0.56–1.08) | 49.5 | 0.55 (0.38–0.78) | 53.1 |
| p for interaction | 0.397 | 0.119 | 0.842 | 0.917 | ||||
| Alcohol intake d | ||||||||
| Non drinker | 0.61 (0.43–0.86) | 54.0 | 0.64 (0.43–0.95) | 56.0 | 0.60 (0.44–0.84) | 54.4 | 0.48 (0.34–0.69) | 60.9 |
| Drinker | ||||||||
| ≤12g of ethanol/day | 0.84 (0.60–1.17) | 48.3 | 0.99 (0.72–1.35) | 34.7 | 0.71 (0.48–1.01) | 55.5 | 0.62 (0.43–0.88) | 59.0 |
| >12–47g of ethanol/day | 0.82 (0.57–1.18) | 59.7 | 0.86 (0.67–1.09) | 21.8 | 0.75 (0.51–1.08) | 63.8 | 0.66 (0.47–0.93) | 59.1 |
| >47 g of ethanol/day | 0.78 (0.50–1.22) | 23.7 | 1.02 (0.56–1.84) | 49.9 | 0.57 (0.42–0.79) | 0.0 | 0.55 (0.37–0.82) | 18.9 |
| p for interaction | 0.559 | 0.359 | 0.647 | 0.605 | ||||
| Controls | ||||||||
| Hospital-basede | 0.67 (0.56–0.79) | 0.0 | 0.88 (0.73–1.06) | 0.0 | 0.60 (0.39–0.95) | 82.9 | 0.50 (0.37–0.68) | 51.6 |
| Population-basedf | 0.74 (0.58–0.94) | 69.3 | 0.78 (0.61–1.00) | 68.1 | 0.74 (0.59–0.91) | 63.9 | 0.63 (0.50–0.81) | 74.1 |
| p for interaction | 0.511 | 0.445 | 0.406 | 0.243 | ||||
| Site g | ||||||||
| Cardia | 0.81 (0.62–1.07) | 11.1 | 0.82 (0.55–1.21) | 39.8 | 0.86 (0.64–1.14) | 18.9 | 0.75 (0.57–1.00) | 22.9 |
| Noncardia | 0.74 (0.60–0.91) | 64.9 | 0.88 (0.72–1.08) | 59.3 | 0.61 (0.50–0.73) | 60.3 | 0.58 (0.45–0.74) | 78.4 |
| p for interaction | 0.606 | 0.755 | 0.051 | 0.179 | ||||
| Histotype h | ||||||||
| Intestinal | 0.83 (0.61–1.13) | 54.3 | 0.87 (0.61–1.24) | 60.0 | 0.72 (0.52–1.00) | 62.5 | 0.73 (0.55–0.98) | 52.3 |
| Diffuse | 0.74 (0.55–1.00) | 34.3 | 0.89 (0.66–1.20) | 30.4 | 0.62 (0.48–0.80) | 19.8 | 0.58 (0.42–0.81) | 50.2 |
| Undifferentiated | 1.04 (0.71–1.41) | 47.5 | 1.08 (0.84–1.40) | 28.9 | 0.77 (0.57–1.02) | 40.6 | 0.93 (0.64–1.36) | 65.3 |
| p for interaction | 0.337 | 0.508 | 0.526 | 0.179 | ||||
| Studies with information on energy intake i | ||||||||
| Adjusting for energy intake | 0.66 (0.54–0.82) | 60.6 | 0.82 (0.68–1.00) | 56.2 | 0.64 (0.49–0.84) | 78.2 | 0.54 (0.42–0.69) | 74.7 |
| Not adjusting for energy intake | 0.81 (0.66–1.00) | 65.1 | 0.99 (0.79–1.25) | 72.1 | 0.75 (0.62–0.90) | 60.1 | 0.68 (0.60–0.78) | 29.6 |
| Studies with information on H. pylori (HP) infection status j | ||||||||
| Adjusting for HP infection | 0.70 (0.49–1.00) | 58.0 | 0.76 (0.49–1.19) | 64.7 | 0.69 (0.51–0.93) | 45.4 | 0.59 (0.41–0.84) | 62.6 |
| Not adjusting for HP infection | 0.70 (0.50–1.00) | 58.4 | 0.76 (0.48–1.19) | 66.5 | 0.68 (0.51–0.91) | 43.9 | 0.59 (0.42–0.83) | 61.2 |
95% CI – 95% Confidence Interval; HP – Helicobacter pylori; OR – Odds Ratio.
Pooled ORs were computed using random-effects models. Study-specific ORs were adjusted, when available and applicable, for sex, age (five-year age groups: <40;40–45; …; 70–75; >75), socioeconomic status (low, intermediate, or high, as defined in each original study based on education, income or occupation), smoking status (never, former and current smokers of ≤10 cigarettes/day; 10 to 20 cigarettes per day; >20 cigarettes/day), alcohol drinking (never, low: ≤12g of ethanol/day, intermediate: >12 to ≤47 g/day, high: >47g/day), salt intake (study-specific tertiles), red and processed meat intake (study-specific tertiles), other fruits/vegetables intake (study-specific tertiles), total energy intake (study-specific quintiles), study center (for multicenter studies) and race/ethnicity (White, Black/African American, Asian, Hispanic/Latino, other).
As defined in each original study based on education, income or occupation.
Excluding study China 4.18
Includes studies Brazil 1,13 China 1,17 Greece,19 Italy 1,22 Italy 2,23 Italy 3,24 Japan 3,26 Mexico 3,29 Spain 233 and USA 1.34 Excluding studies Brazil 212 and Russia31 as they include both hospital- and population-based controls.
Includes studies Canada,14 China 2,15 China 3,16 China 4,18 Iran 1,20 Iran 2,21 Italy 4,25 Mexico 1,27 Mexico 2,28 Portugal,30 Spain 1,32 Sweden 111 and Sweden 2.11 Excluding studies Brazil 212 and Russia31 as they include both hospital- and population-based controls.
Excluding studies China 1,17 China 2,15 China 3,16 China 4,18 Greece,19 Italy 1,22 Japan 3,26 Mexico 2,28 Sweden 111 and Sweden 2.11
No information for studies Brazil 1,13 Brazil 2,12 Canada,14 China 1,17 China 2,15 China 4,18 Iran 1,20 Italy 3, Russia,31 Sweden 1,11 Sweden 211 and USA1.34
No information for studies Canada,14 China 1,17 China 3,16 China 4,18 Greece,19 Italy 1,22 Italy 2,23 Italy 3,24 Italy 4,25 Mexico 2,28 Spain 2,33 Sweden 1,11 Sweden 211 and USA1.34 H. pylori infection was defined using the same criteria of the original studies, according to the following serological tests: enzyme-linked immunosorbent assay (ELISA) tests (nine studies)12, 13, 15, 20, 26, 27, 29–31 or Western Blot (one study)21 to determine immunoglobulin G (IgG) antibody titers in serum, and in one study through multiplex serology.32 When anti-H. pylori serum IgG titers were assessed using an ELISA-based method, participants with borderline results were classified as testing positive for H. pylori infection.