Low sodium diet for gastric cancer prevention in the United States: Results of a Markov model

Abstract

Background and Aims High sodium consumption has been associated with an increased risk of gastric cancer. The mean daily sodium intake in the United States substantially exceeds the national recommended amount. The low sodium‐DASH diet has been shown to decrease the risk of cardiovascular disease in the United States, but its impact on gastric cancer has not been well studied. We therefore aimed to model the impact and cost‐effectiveness of the low sodium‐DASH diet for gastric cancer prevention in the U.S. population. Methods A Markov cohort state‐transition model was developed to simulate the impact of the low sodium‐DASH diet on gastric cancer outcomes for the average 40‐year‐old in the United States compared to no intervention. Primary outcomes of interest were gastric cancer incidence and incremental cost‐effectiveness ratios (ICER). Results Our model found that compared to the no intervention cohort, the risk of gastric cancer decreased by 24.8% for males and 21.2% for females on the low sodium‐DASH diet. 27 cases and 14 cases per 10,000 individuals were prevented for males and females, respectively, in the intervention group. The ICER for the low sodium‐DASH diet strategy was $287,726 for males and $423,878 for females compared to the no intervention strategy. Conclusions Using a Markov model of gastric cancer risk, we found that adherence to a low sodium‐DASH diet could decrease the risk of gastric cancer. This intervention was not cost‐effective due to the high cost of a low sodium‐DASH accordant diet, but significantly improved for high‐risk populations and when the cost of the diet became slightly more affordable.

Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019 – 2030: a modelling study

“…Another recent modelling study in the United States has shown that compared to status quo, a low-sodium DASH diet could reduce the lifetime risk of stomach cancer by 24.8% in men and 21.2% in women. In addition, this prevented 27 and 14 stomach cancer cases per 10,000 people respectively for men and women and postponed 24 stomach cancer deaths in men and 13 stomach cancer deaths in women per 10,000 persons (23).…”

“…Another recent modelling study in the United States has shown that compared to status quo, a low-sodium DASH diet could reduce the lifetime risk of stomach cancer by 24.8% in men and 21.2% in women. In addition, this prevented 27 and 14 stomach cancer cases per 10,000 people respectively for men and women and postponed 24 stomach cancer deaths in men and 13 stomach cancer deaths in women per 10,000 persons (23). Despite differences in modelling approaches, with Kypridemos et al using dynamic microsimulation and the latter study using Markov models, the results from these studies are akin to our findings - demonstrating the substantial avoidable stomach cancer burden from population-wide salt reduction.…”

The Epidemiological Characteristics of Noncommunicable Diseases and Malignant Tumors in Guiyang, China: Cross-sectional Study

“…Moreover, our MT findings appear to be at odds with the latest research reports around the world, as the latest cancer statistics [ 2 ] show that there is no gastric cancer among the top 10 most common MTs in men and no cervical cancer among the top 10 most common MTs in women. Previous studies [ 24 , 25 ] have shown that diet is closely related to the occurrence of gastric cancer, and a low-sodium diet can significantly reduce the incidence of gastric cancer. Several studies [ 26 , 27 ] have also found that human papillomavirus (HPV) infection is significantly associated with cervical cancer, and a small number of studies [ 28 , 29 ] have also revealed a high HPV infection rate among women in Guizhou.…”

Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019–2030: a modelling study

“…Another recent modelling study in the USA has shown that compared with status quo, a low-Na DASH diet could reduce the lifetime risk of stomach cancer by 24•8 % in men and 21•2 % in women. In addition, this prevented twenty-seven and fourteen stomach cancer cases per 10 000 people, respectively, for men and women and postponed twenty-four stomach cancer deaths in men and thirteen stomach cancer deaths in women per 10 000 persons (24) . Despite differences in modelling approaches, with Kypridemos et al using dynamic microsimulation and the latter study using Markov models, the results from these studies are akin to our findingsdemonstrating the substantial avoidable stomach cancer burden from population-wide salt reduction.…”