PurposeThe relationship between whole and refined grain intake and gastric cancer risk has been investigated, but findings remain inconclusive. We aimed to evaluate and quantify the association of whole and refined grain consumption with gastric cancer risk through an individual participant pooled analysis of studies participating in the Stomach cancer Pooling (StoP) Project.MethodsTwenty case-control studies (including 7,943 cases and 19,729 controls) contributed to the analysis of refined grains, and 13 of these (5,658 cases and 15,802 controls) contributed to the analysis of whole grains. Study-specific odds ratios (ORs) were estimated using multivariable logistic regression models and pooled through a two-stage approach based on fixed-effects models.ResultsFor whole grains, compared with no consumption, the OR was 0.92 (95% confidence interval, CI: 0.84-1.01) for any consumption, and 0.86 (95% CI: 0.77-0.96) for a consumption equal or above the study-specific median. There was an increasing risk of gastric cancer with increasing consumption of refined grains, with an OR for the highest versus the lowest tertile of 1.39 (95% CI: 1.28-1.50) when considering staple grain foods only and 1.52 (95% CI: 1.39-1.65) when also considering grain-based sweets and desserts.ConclusionOur findings indicate that whole grain consumption is inversely associated, and refined grain consumption directly associated with gastric cancer risk. These findings support current dietary recommendations favoring whole grains over refined grains.

Pro-vegetarian (PVG) diets may reduce gastric cancer (GC) risk, but evidence remains limited. We aimed to evaluate the association between three predefined PVG patterns—general (gPVG), healthful (hPVG), and unhealthful (uPVG)—and GC risk stratifying by sex in the context of the Stomach Cancer Pooling (StoP) Project Consortium. We analysed data from six case–control studies from the StoP Consortium. The final sample included 1,857 incidents, histologically confirmed GC cases and 5,646 controls. Food intakes were assessed using country-specific food frequency questionnaires, which allowed the estimation of PVG patterns using established scoring methods. Adherence to PVG dietary patterns was classified into quintiles. Logistic mixed models with random intercepts for each study were used to estimate odds ratios (ORs) and 95

BACKGROUND:Occupational heat stress occurs frequently and is increasing with climate change. Studies of occupational heat exposure and stomach cancer risk are limited. We used data from the international Stomach cancer Pooling (StoP) Project to investigate the relationship between occupational heat exposure and stomach cancer risk in a pooled analysis of two Spanish case-control studies, including 566 stomach cancer cases and 2984 controls. METHODS:The Spanish job-exposure matrix, MatEmEsp, was used to assign heat exposure estimates to participant occupations. We evaluated three exposure indices: ever vs. never exposed, cumulative exposure and duration (years). We calculated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) using unconditional logistic regression models including terms for potential confounders. RESULTS:Overall, 60.6 % of cases and 42.7 % of controls were ever occupationally exposed to heat. Occupational heat exposure was associated with a moderately elevated risk of stomach cancer (OR 1.31; 95 % CI 1.05, 1.63) when comparing ever vs. never exposed individuals in both studies combined. Elevated ORs were also observed across categories of cumulative exposure and duration (p-trend = 0.01 and 0.03, respectively). Findings were robust to additional covariate adjustment and in analysis of never smokers. There was no clear evidence for interaction according to exposure status to other suspected occupational stomach carcinogens. CONCLUSION:Findings from this study provide some evidence for a positive association between occupational heat exposure and stomach cancer risk. Further research is needed to advance occupational heat assessment tools for epidemiological research as well as studies in more geographically diverse populations.

Supplementary Table 2: Questionnaire items used to assess exposure for each study included in the analysis.

Gastric cancer is among the most common cancer and cause of cancer death. We conducted a meta-analysis of 25 case-control studies from the Stomach cancer Pooling Project to assess the association between fish or canned fish consumption and the risk of gastric cancer. 10,431 cases and 24,903 controls were available. We found no association between fish consumption and risk of gastric cancer (pooled odds ratios (OR) = 0.99; 95% confidence interval (CI) 0.86-1.13, for at least one serving/week vs none). Geographical differences were found: in Asia an increased intake of fish was associated with a lower stomach cancer risk. In the sensitivity analyses, fish consumption was associated to a lower risk of gastric cancer in models adjusted for family history of gastric cancer (OR = 0.80, 95% CI 0.72-0.89) and Helicobacter Pylori infection (OR = 0.72, 95% CI 0.60-0.88), but not for body mass index or energy intake. Seven studies collected information on canned fish (4525 cases and 8073 controls). No association was found for canned fish (OR = 0.96, 95% CI 0.82-1.13). In conclusion, our results provide evidence that fish and canned fish intake are not associated with gastric cancer risk, although geographical differences have been highlighted, with a lower risk of gastric cancer in Asia.

Introduction: Prurigo nodularis (PN) is a chronic inflammatory skin disease with recent definition and relatively low prevalence. Information on PN, including its epidemiology, severity, and burden of disease is still scanty. Objectives: We sought to review and summarize recent quantitative data on PN in Europe, and to estimate the burden of disease in Italy with a focus on moderate-to-severe PN. Methods: We conducted a systematic literature review of recent studies on the epidemiology of PN in Europe, using PubMed/Medline and EMBASE. The study selection process was conducted independently by 2 reviewers. Articles focused on the severity of PN were also searched, and relevant information was extracted. Synthetic results were combined to population data to derive the best estimate of the burden of PN in Italian adults. Results: Five articles reporting data on incidence and/or prevalence of PN in European populations were identified. The prevalence of PN ranged from 6.5 to 111.0 cases per 100,000, with a median estimate of 32.7 cases per 100,000, the incidence ranging between 2.88 and 20 per 100,000 person-years. Five (other) studies reported data on the severity of PN, measured through pruritus scores, quality-of-life indexes and/or percentage of non-response to treatment. We estimated a total of 16,280 prevalent PN cases in Italy, of whom 6,073 had moderate-to-severe to very severe disease. Among the latter, 1,798 estimated cases were not controlled by standard treatments. Conclusions: We retrieved and summarized recent epidemiological data on PN, evidencing a high burden of disease in Italy and other European countries.

Supplementary Table 1: Main characteristics of the studies included in the analysis.

PURPOSE:The evidence regarding the role of vitamin D on gastric cancer (GC) is controversial. Within the Stomach cancer Pooling (StoP) Project, a global consortium of epidemiological studies on GC, we aimed to evaluate the relationship between dietary vitamin D and GC risk. METHODS:Five case-control studies were included in the analysis, accounting for 1875 cases and 5899 controls. Odds ratios (OR) of GC and the corresponding 95% confidence intervals (CI) for tertiles of vitamin D intake were computed using logistic regression models adjusted for relevant confounders, including energy intake. The pooled ORs were computed using random-effect models. RESULTS:The pooled OR of GC for the highest compared to the lowest tertile of vitamin D intake was 1.06 (95% CI 0.80-1.39), with a p for heterogeneity of 0.019. No significant association was found across strata of sex, age, socioeconomic status, smoking status, alcohol intake, and vegetable and fruit consumption. CONCLUSIONS:Our pooled analysis indicates that there is no association between dietary vitamin D and the risk of GC.

Supplementary Table 3: History of exposure to proton-pump inhibitors (PPIs) among cases and controls, according to different exposure definitions.

Supplementary Figure 2: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer, by smoking status and alcohol drinking status.

Supplementary Table 4: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer from the leave-one-out meta-analysis.

Supplementary Figure 1: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer, stratified by H. pylori infection and socioeconomic status (SES).

Background Previous studies suggest that dietary vitamin C is inversely associated with gastric cancer (GC), but most of them did not consider intake of fruit and vegetables. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project, a consortium of epidemiological studies on GC. Methods Fourteen case–control studies were included in the analysis (5362 cases, 11,497 controls). We estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between dietary intake of vitamin C and GC, adjusted for relevant confounders and for intake of fruit and vegetables. The dose–response relationship was evaluated using mixed-effects logistic models with second-order fractional polynomials. Results Individuals in the highest quartile of dietary vitamin C intake had reduced odds of GC compared with those in the lowest quartile (OR: 0.64; 95% CI: 0.58, 0.72). Additional adjustment for fruit and vegetables intake led to an OR of 0.85 (95% CI: 0.73, 0.98). A significant inverse association was observed for noncardia GC, as well as for both intestinal and diffuse types of the disease. The results of the dose–response analysis showed decreasing ORs of GC up to 150–200 mg/day of vitamin C (OR: 0.54; 95% CI: 0.41, 0.71), whereas ORs for higher intakes were close to 1.0. Conclusions The findings of our pooled study suggest that vitamin C is inversely associated with GC, with a potentially beneficial effect also for intakes above the currently recommended daily intake (90 mg for men and 75 mg for women).

Background Tobacco smoking is still frequent in Italy and a major cause of cancer globally. We estimated the burden of smoking-related cancer in Italy. Methods To calculate the population attributable fraction (PAF), we adopted a counterfactual scenario for which all individuals never smoked. The PAF of current and former smoking and second-hand smoke (SHS) was estimated for cancers associated with these habits according to the International Agency for Research on Cancer. Relative risk estimates and prevalence of exposure were derived from large-scale studies and national surveys, respectively. A 20-year latency period between exposure and cancer was considered. Cancer incidence data for 2020 and mortality data for 2017 were obtained from the Italian Association of Cancer Registries. Results Tobacco smoking caused, in men and women respectively, 90.0 % and 58.3 % of lung; 67.8 % and 53.5 % of pharyngeal; 47.0 % and 32.2 % of bladder; 45.9 % and 31.7 % of oral; 36.6 % and 23.6 % of esophageal; 23.0 % and 14.0 % of pancreatic cancer and lower percentages of cancers at other sites. Tobacco smoking accounted for 23.9 % and 7.7 % of new cancer cases in 2020, and 32.1 % and 11.3 % of cancer deaths in 2017 in men and women, respectively, corresponding to 17.3 % of cases and 24.5 % of cancer deaths overall. The PAF of lung cancer due to SHS in never smoking women married with smokers was 13.0 %. Conclusions Tobacco smoking is a primary cause of cancer in Italy in both sexes. Tobacco control policies are warranted.

We updated to December 2023 the main findings of the stomach cancer pooling (StoP) project including about 13 000 cases and 31 000 controls from 29 case-control and 5 nested studies. The StoP project quantified more precisely than previously available the positive associations of tobacco smoking, high alcohol consumption, meat intake, selected occupations (e.g. agricultural and miners), gastric ulcer and family history with gastric cancer and the inverse associations with socioeconomic status and selected aspects of diet (fruits, including citrus fruits, vegetables, including allium and mushrooms, and polyphenols). No consistent associations were found with coffee, yoghurt and leisure-time physical activity, metformin or proton pump inhibitors use.

Cancer burden can be reduced by controlling modifiable risk factors, including diet. We provided an evidence-based assessment of cancer cases and deaths attributable to diet in Italy in 2020. We considered dietary factor-cancer type pairs for which the World Cancer Research Fund/American Institute for Cancer Research - Continuous Update Project reported either 'convincing' or 'probable' evidence of causal association. Relative risks were retrieved from recent meta-analyses and dietary intakes (around 2005) from a national food consumption survey. Sex-specific population attributable fractions (PAFs) were computed by comparing the distribution of dietary intakes in the Italian population against counterfactual scenarios based on dietary recommendations. Using data from national cancer and mortality registries in 2020, we estimated the number of attributable cancer cases and deaths, assuming ~15-year lag period. Unhealthy diet accounted for 6.3% (95% CI: 2.5%-9.9%) of all cancer cases in men and 4.5% (95% CI: 1.7%-7.4%) in women. PAFs of colorectal cancer were 10.5% and 7.0% for any intake of processed meat, 3.3% and 2.0% for high red meat, 4.8% and 4.3% for low dairy products, and 7.9% and 9.0% for low fiber intakes in men and women, respectively. PAFs for low intake of non-starchy vegetables and fruit ranged from 0.8% to 16.5% in men and 0.6%-17.8% in women for cancers of the aerodigestive tract. The estimated cancer burden associated with unfavorable dietary habits in Italy is considerable, but appears lower than for other high-income countries, reflecting the typically Mediterranean diet.

Dietary isoflavones have been associated with a lower risk of gastric cancer (GC), but the evidence for this association is still limited. We investigated the association between isoflavone intake and GC risk using data from a case–control study including 230 incident, histologically confirmed GC cases and 547 controls with acute, non-neoplastic conditions. Dietary information was collected through a validated food frequency questionnaire (FFQ) and isoflavone intake was estimated using ad hoc databases. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of GC using logistic regression models, including terms for total energy intake and other major confounders. The OR for the highest versus the lowest tertile of intake was 0.65 (95%CI = 0.44–0.97, p for trend = 0.04) for daidzein, 0.75 (95%CI = 0.54–1.11, p for trend = 0.15) for genistein, and 0.66 (95%CI = 0.45–0.99, p for trend = 0.05) for total isoflavones. Stratified analyses by sex, age, education, and smoking showed no heterogeneity. These findings indicate a favorable effect of dietary isoflavones on GC.

BackgroundAspirin and statins have been suggested to have potential chemopreventive effects against gastric cancer (GC), although the results of previous studies have been inconsistent. This study therefore aimed to investigate the association between the use of aspirin and statins and GC.MethodsA pooled analysis of seven case-control studies within the Stomach Cancer Pooling Project, including 3220 cases and 9752 controls, was conducted. Two-stage modeling analyses were used to estimate the association between aspirin and statin use and GC after adjusting for potential confounders.ResultsThe pooled odds ratio (OR) of GC for aspirin users versus nonusers was 0.72 (95% confidence interval [CI], 0.54-0.95). The protective effect of aspirin appeared stronger in individuals without a GC family history (OR, 0.60; 95% CI, 0.37-0.95), albeit with borderline heterogeneity between those with and without a family history (p = .064). The OR of GC decreased with increasing duration of aspirin use, with an OR of 0.41 (95% CI, 0.18-0.95) for durations of >= 15 years. An inverse, nonsignificant association with the risk of GC was observed for the use of statins alone (OR, 0.79; 95% CI, 0.52-1.18).ConclusionsThese findings suggest that aspirin use, particularly long-term use, is associated with a reduced risk of GC, whereas a similar association was not observed with statins, possibly because of the low frequency of use. Aspirin use, particularly long-term use, is associated with a reduced risk of gastric cancer.In this study, statin use was not significantly associated with gastric cancer risk in the populations studied, possibly because of the low frequency of use, which resulted in limited statistical power.

BACKGROUND:Evidence on the potential association between dietary copper intake and gastric cancer (GC) is lacking. Thus, we aimed to evaluate this association within the Stomach cancer Pooling (StoP) Project-an international consortium of epidemiological studies on GC. METHODS:Data from five case-control studies within the StoP Project were included (2448 cases, 4350 controls). We estimated adjusted odds ratios (ORs) and 95% CIs for the association between dietary copper intake and GC using multivariable mixed-effects logistic regression models. We also modelled the dose-response relationship between copper intake and GC using a logistic mixed-effects model with fractional polynomial. RESULTS:The OR for the highest quartile of copper intake compared with the lowest one was 0.78 (95% CI: 0.63-0.95; P for trend = 0.013). Results were similar for non-cardia-type (OR: 0.72; 95% CI: 0.57-0.91), intestinal-type (OR: 0.75; 95% CI: 0.56-0.99) and other histological-type GC (OR: 0.65; 95% CI: 0.44-0.96). The dose-response analysis showed a steep decrease in ORs for modest intakes (<1 mg/day), which were subsequently steady for ≤3 mg/day (OR: 0.09; 95% CI: 0.02-0.41) and slowly increased for higher intakes. CONCLUSIONS:The findings of our large study suggest that copper intake might be inversely associated with GC, although their confirmation by prospective studies is required.