Diet and Risk of Gastric Cancer: An Umbrella Review

Several dietary exposures have been associated with gastric cancer (GC), but the associations are often heterogenous and may be afflicted by inherent biases. In the context of an Umbrella Review (UR), we provide an overview and a critical evaluation of the strength and quality, and evidence classification of the associations of diet-related exposures in relation to the risk of GC. We searched PubMed and Scopus for eligible meta-analyses of observational studies published in English from inception to 12 December 2021, and for any identified association, we applied robust epidemiological validity evaluation criteria and individual study quality assessment using AMSTAR. We screened 3846 titles/abstracts and assessed 501 full articles for eligibility, of which 49 were included in the analysis, investigating 147 unique exposures in relation to GC, cardia (GCC) or non-cardia (GNCC) cancer. Supported by suggestive evidence, positive associations were found comparing the highest vs. lowest categories for: heavy (>42 g/day) alcohol consumption (Relative Risk (RR) = 1.42, 95% Confidence Interval (CI): 1.20-1.67), salted fish consumption (RR = 1.56, 95% CI:1.30-1.87) and waist circumference (RR = 1.48, 95% CI:1.24-1.78) and an inverse association for the healthy lifestyle index (RR = 0.60, 95% CI:0.48-0.74) in relation to GC. Additionally, a positive association was found comparing obese individuals (Body Mass Index (BMI) >= 30) to normal-weight individuals (BMI: 18.5-25) (RR = 1.82, 95% CI:1.32-2.49) in relation to GCC. Most of the meta-analyses were of medium-to-high quality (median items: 7.0, interquartile range: 6-9). Maintaining a normal body weight and adopting healthy dietary choices, in particular, limiting the consumption of salt-preserved foods and alcohol, can reduce the risk of gastric cancer.