Dietary intake of heme iron and risk of gastric cancer in the European prospective investigation into cancer and nutrition study

Abstract

Even though recent studies suggest that a high intake of heme iron is associated with several types of cancer, epidemiological studies in relation to gastric cancer (GC) are lacking. Our previous results show a positive association between red and processed meat and non cardia gastric cancer, especially in Helicobacter pylori infected subjects. The aim of the study is to investigate the association between heme iron intake and GC risk in the European prospective investigation into cancer and nutrition (EURGAST‐EPIC). Dietary intake was assessed by validated center‐specific questionnaires. Heme iron was calculated as a type‐specific percentage of the total iron content in meat intake, derived from the literature. Antibodies of H. pylori infection and vitamin C levels were measured in a sub‐sample of cases and matched controls included in a nested case‐control study within the cohort. The study included 481,419 individuals and 444 incident cases of GC that occurred during an average of 8.7 years of followup. We observed a statistically significant association between heme iron intake and GC risk (HR 1.13 95% CI: 1.01–1.26 for a doubling of intake) adjusted by sex, age, BMI, education level, tobacco smoking and energy intake. The positive association between heme iron and the risk of GC was statistically significant in subjects with plasma vitamin C <39 mmol/l only (log2 HR 1.54 95% CI (1.01–2.35). We found a positive association between heme iron intake and gastric cancer risk.

A Population-based Case-control Study on Risk Factors for Gastric Cardia Cancer in Rural Areas of Linzhou

“…With the development of economic in rural areas in China, both the consumption of fresh vegetables and fruits were proved to be protective factors, which was opposite to the report 10 years ago in Linzhou (Sun et al, 2002). Moreover, effects of taking fresh vegetables and fruits against gastric cancer may be mediated by ascorbic acid, heme iron and Selenium, which is consistent with the former epidemiological studies (Hill, 1998;Ward et al, 1999;Cai et al, 2003;Rayman, 2005;Jakszyn et al, 2012). One European largescale prospective study had also confirmed that greater adherence to a relative Mediterranean diet was associated with a significant reduction in the risk of incident for gastric adenocarcinoma (Buckland et al, 2010).…”

Iron and Cancer Risk—A Systematic Review and Meta-analysis of the Epidemiological Evidence

“…There were 2 studies that included vitamin C in their analyses. One of them found a positive association between heme iron and gastric cancer in subjects with low levels of vitamin C in plasma (59), whereas the other study found an important increased risk of lung cancer in postmenopausal women with higher intakes of heme iron and high dosage of vitamin C (71).…”

“…58-63). One of the biggest studies researching heme iron and gastric cancer risk (444 cases) was conducted within the European Prospective Investigation into Cancer and Nutrition Study (59) and found a statistically significant association between heme iron intake and gastric cancer risk, showing that subjects in the top quartile of heme iron intake had a 70% higher risk of developing gastric cancer than the lowest consumers (RR, 1.67; 95% CI, 1.20-2.34). A small case-control study with 92 cases (62) showed a statistically significant negative association between dietary iron and gastric cancer risk (OR, 0.41; 95% CI, 0.19-0.89).…”

Sequence analysis of the E-cadherin (CDH1) gene in a cohort of gastric cancers seen in the western cape

“…Another dietary factor contributing towards the development of stomach cancer is heme iron. A U n i v e r s i t y o f C a p e T o w n 12 study carried out in 444 individuals to investigate the impact of heme iron showed that there was a 70% greater chance of developing stomach cancer in individuals with an increased heme iron in their diet (Jakszyn et al, 2011).…”