Table 4.
Pooled odds ratios (ORs) and 95% confidence intervals (CIs) of gastric cancer for the highest compared to the lowest study-specific tertile of different sources of meat in strata of selected variables.
| White Meat | Red Meat | Processed Meat | Total Meat | |||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| OR (95% CI) [1] | I2 (%) | OR (95% CI) [1] | I2 (%) | OR (95% CI) [1] | I2 (%) | OR (95% CI) [1] | I2 (%) | |
|
| ||||||||
| Overall | 1.09 (0.93–1.26) | 56.4 | 1.24 (1.00–1.53) | 82.3 | 1.23 (1.06–1.43) | 60.2 | 1.30 (1.09–1.55) | 77.9 |
| Sex | ||||||||
| Men | 1.00 (0.89–1.13) | 5.4 | 1.19 (0.97–1.46) | 65.6 | 1.21 (1.05–1.38) | 26.4 | 1.23 (1.05–1.45) | 52.3 |
| Women | 1.27 (0.94–1.70) | 67.4 | 1.28 (0.96–1.69) | 69.0 | 1.29 (0.99–1.68) | 64.0 | 1.41 (1.06–1.86) | 72.4 |
| P for interaction | 0.146 | 0.690 | 0.656 | 0.421 | ||||
| Age (years) | ||||||||
| ≤55 | 1.04 (0.86–1.27) | 14.5 | 1.05 (0.78–1.42) | 62.6 | 1.39 (1.18–1.63) | 2.1 | 1.10 (0.90–1.35) | 35.0 |
| >55 to ≤65 | 1.19 (0.93–1.54) | 42.2 | 1.26 (0.95–1.66) | 60.6 | 1.19 (0.93–1.53) | 46.0 | 1.44 (1.10–1.88) | 61.0 |
| >65 | 0.97 (0.83–1.14) | 12.4 | 1.38 (1.09–1.75) | 59.9 | 1.13 (0.92–1.39) | 45.2 | 1.33 (1.07–1.67) | 58.2 |
| P for interaction | 0.389 | 0.364 | 0.265 | 0.238 | ||||
| Area | ||||||||
| Europe | 1.15 (0.88–1.52) | 72.2 | 1.27 (0.91–1.78) | 81.4 | 1.28 (1.02–1.60) | 55.3 | 1.42 (1.06–1.89) | 72.1 |
| Asia | 0.97 (0.72–1.30) | 60.0 | 0.94 (0.59–1.51) | 87.3 | 0.98 (0.80–1.20) | 27.3 | 1.01 (0.74–1.38) | 81.1 |
| Americas | 1.07 (0.86–1.33) | 0.0 | 1.49 (1.01–2.20) | 76.7 | 1.45 (1.14–1.84) | 42.4 | 1.51 (1.09–2.08) | 66.6 |
| P for interaction | 0.700 | 0.330 | 0.038 | 0.159 | ||||
| Socioeconomic status [2] | ||||||||
| Low | 1.19 (0.91–1.57) | 61.1 | 1.33 (1.04–1.70) | 61.5 | 1.25 (1.00–1.55) | 47.4 | 1.33 (1.09–1.63) | 47.6 |
| Intermediate | 0.91 (0.73–1.13) | 14.1 | 1.13 (0.81–1.58) | 66.4 | 1.25 (0.95–1.63) | 49.9 | 1.28 (0.95–1.74) | 62.5 |
| High | 1.10 (0.79–1.53) | 0.0 | 0.99 (0.57–1.71) | 62.4 | 1.34 (0.96–1.86) | 15.8 | 1.20 (0.80–1.82) | 51.6 |
| P for interaction | 0.280 | 0.540 | 0.934 | 0.903 | ||||
| Smoking status | ||||||||
| Never | 1.24 (0.97–1.59) | 63.2 | 1.29 (0.99–1.69) | 72.4 | 1.18 (0.93–1.49) | 60.1 | 1.33 (1.04–1.69) | 70.5 |
| Former | 1.01 (0.85–1.19) | 0.0 | 1.28 (1.08–1.52) | 4.3 | 1.31 (1.06–1.62) | 24.1 | 1.32 (1.14–1.53) | 0.7 |
| Current | 0.89 (0.72–1.11) | 14.3 | 1.04 (0.76–1.41) | 55.3 | 1.10 (0.93–1.30) | 0.0 | 1.08 (0.88–1.32) | 26.5 |
| P for interaction | 0.138 | 0.458 | 0.446 | 0.238 | ||||
| Alcohol drinking | ||||||||
| Non-drinker | 1.17 (0.97–1.46) | 33.4 | 1.31 (0.97–1.75) | 72.2 | 1.24 (1.02–1.50) | 32.3 | 1.34 (1.05–1.73) | 66.6 |
| Drinker | ||||||||
| Low (≤12 g/day) | 1.19 (0.88–1.59) | 50.2 | 1.10 (0.79–1.53) | 67.7 | 1.32 (0.97–1.81) | 60.5 | 1.26 (0.92–1.72) | 68.1 |
| Intermediate (>12–47 g/day) | 0.90 (0.70–1.15) | 15.3 | 1.23 (0.98–1.53) | 13.4 | 0.98 (0.75–1.28) | 32.0 | 1.20 (1.02–1.39) | 0.0 |
| High (>47 g/day) | 0.96 (0.57–1.61) | 36.5 | 1.03 (0.65–1.63) | 31.7 | 1.54 (1.12–2.12) | 0.0 | 1.42 (1.06–1.91) | 0.0 |
| P for interaction | 0.312 | 0.792 | 0.175 | 0.642 | ||||
| Controls | ||||||||
| Hospital-based[3] | 1.05 (0.87–1.26) | 17.3 | 1.51 (1.09–2.11) | 76.4 | 1.31 (1.03–1.66) | 54.0 | 1.42 (1.08–1.86) | 72.6 |
| Population-based[4] | 1.10 (0.89–1.40) | 72.5 | 1.05 (0.80–1.38) | 84.8 | 1.17 (0.96–1.44) | 68.1 | 1.20 (0.94–1.53) | 81.8 |
| P for interaction | 0.687 | 0.096 | 0.505 | 0.372 | ||||
| Site [5] | ||||||||
| Cardia | 1.30 (0.96–1.75) | 15.8 | 1.61 (0.99–2.63) | 69.0 | 1.34 (0.97–1.84) | 29.3 | 1.76 (1.15–2.70) | 59.5 |
| Non-cardia | 1.11 (0.95–1.30) | 53.8 | 1.28 (1.03–1.59) | 78.7 | 1.24 (1.03–1.49) | 68.3 | 1.34 (1.11–1.62) | 74.9 |
| P for interaction | 0.370 | 0.406 | 0.676 | 0.255 | ||||
| Histological type [6] | ||||||||
| Intestinal | 1.19 (0.91–1.55) | 48.9 | 1.67 (1.04–2.66) | 81.9 | 1.17 (0.84–1.65) | 66.2 | 1.50 (1.06–2.13) | 73.8 |
| Diffuse | 1.28 (1.03–1.58) | 11.0 | 1.34 (0.91–1.98) | 63.4 | 1.44 (1.16–1.80) | 12.4 | 1.46 (1.12–1.90) | 46.1 |
| Undifferentiated | 1.33 (0.84–2.09) | 55.3 | 1.56 (0.85–2.87) | 69.6 | 1.23 (0.87–1.74) | 50.7 | 1.57 (0.98–2.53) | 61.7 |
| P for interaction | 0.883 | 0.770 | 0.532 | 0.964 | ||||
| Vegetables and fruits intake | ||||||||
| Low | 1.04 (0.83–1.30) | 17.4 | 1.02 (0.79–1.33) | 49.9 | 1.33 (1.04–1.71) | 43.6 | 1.12 (0.90–1.38) | 39.1 |
| Intermediate | 0.97 (0.83–1.12) | 0.0 | 1.29 (1.02–1.62) | 44.3 | 1.23 (1.00–1.52) | 34.9 | 1.32 (1.07–1.63) | 44.5 |
| High | 1.23 (0.99–1.53) | 40.3 | 1.23 (0.89–1.71) | 75.8 | 1.16 (0.92–1.45) | 50.5 | 1.38 (1.02–1.88) | 75.0 |
| P for interaction | 0.188 | 0.413 | 0.711 | 0.418 | ||||
| Family history of GC [7] | ||||||||
| No | 1.12 (0.91–1.37) | 62.0 | 1.36 (1.01–1.85) | 85.2 | 1.11 (0.90–1.36) | 60.7 | 1.31 (1.04–1.67) | 79.2 |
| Yes | 1.16 (0.91–1.48) | 0.0 | 1.19 (0.68–2.07) | 77.9 | 1.30 (0.84–1.99) | 37.2 | 1.56 (0.83–2.93) | 68.9 |
| P for interaction | 0.824 | 0.671 | 0.518 | 0.626 | ||||
| Body Mass Index (BMI) (kg/m2) | ||||||||
| <18.5 | 0.56 (0.14–2.27) | 60.9 | 1.76 (0.66–4.73) | 43.7 | 0.94 (0.25–3.56) | 55.2 | 0.97 (0.62–1.53) | 0.7 |
| 18.5–25 | 1.00 (0.86–1.15) | 5.7 | 1.24 (1.01–1.52) | 43.0 | 1.15 (0.89–1.50) | 64.1 | 1.29 (1.01–1.66) | 70.2 |
| 25–30 | 1.03 (0.75–1.42) | 59.0 | 1.15 (0.84–1.58) | 61.7 | 1.46 (1.18–1.81) | 22.8 | 1.28 (1.01–1.63) | 42.3 |
| >30 | 1.50 (0.83–2.69) | 65.8 | 1.37 (0.73–2.59) | 58.9 | 1.37 (0.98–1.91) | 0.0 | 1.51 (1.02–2.22) | 36.0 |
| P for interaction | 0.485 | 0.852 | 0.530 | 0.553 | ||||
| Studies with information on total energy intake [7] | ||||||||
| Adjusting for energy | 1.02 (0.82–1.26) | 63.0 | 1.06 (0.84–1.33) | 68.9 | 1.16 (1.00–1.35) | 35.9 | 1.22 (1.06–1.41) | 35.7 |
| Not-adjusting for energy | 1.06 (0.86–1.31) | 64.4 | 1.22 (0.95–1.56) | 77.8 | 1.31 (1.10–1.56) | 54.9 | 1.36 (1.13–1.63) | 64.3 |
| Studies with information on H. pylori (HP) infection [8] | ||||||||
| Adjusting for HP | 1.22 (0.92–1.62) | 60.3 | 1.29 (0.77–2.17) | 89.7 | 1.15 (0.91–1.46) | 44.6 | 1.35 (0.93–1.96) | 82.6 |
| Not-adjusting for HP | 1.21 (0.91–1.60) | 66.0 | 1.25 (0.76–2.04) | 89.9 | 1.15 (0.88–1.49) | 61.3 | 1.28 (0.89–1.82) | 84.5 |
Pooled ORs were computed using random-effects models, which included, when available and applicable, terms for sex, age (5-year age groups: <40;40–44; …; 70–74; ≥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; 11 to 20 cigarettes/day; >20 cigarettes/day), alcohol drinking (never, low: ≤12 g of ethanol/day, intermediate: >12 to 47 g of ethanol/day, high: >47 g of ethanol/day), fruits and vegetables consumption (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”, family history of gastric cancer and body mass categories (<18.5; 18.5–25; 25–30; >30 kg/m2).
No information for the study Japan 2.23 As defined in each original study based on education, income or occupation.
Includes studies Brazil 1,13 Brazil 2,12 Greece,17 Italy 1,19 Italy 2,20 Italy 3,21 Japan 1,24 Japan 2,25 Japan 3,23 Mexico 3,27 Russia30 and Spain 2.32
Includes studies Canada,14 China 2,15 China 3,16 Iran 1,18 Italy 4,22 Mexico 1,26 Mexico 2,28 Portugal29 and Spain 1.31
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 (9 studies)12, 13, 18, 23, 24, 26, 27, 29, 30 to determine immunoglobulin G (IgG) antibody titers in serum, and in one study through multiplex serology.31 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.