J Gastric Cancer.
2025 Apr;25(2):285-302. 10.5230/jgc.2025.25.e16.
Environmental Protective and Risk Factors for Gastric Cancer: An Umbrella Review and Reanalysis of Meta-Analyses
- Affiliations
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- 1Korea University Anam Hospital, Seoul, Korea
- 2Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
- 3Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- 4Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- 5Division of Foregut Surgery, Korea University College of Medicine, Seoul, Korea
- 6Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- 7Gut and Metabolism Laboratory, Korea University College of Medicine, Seoul, Korea
- 8Department of General Surgery, The Jordanian Ministry of Health, Princes Hamzh Hospital, Amman, Jordan
- 9Yonsei University College of Medicine, Seoul, Korea
- 10Kyung Hee University College of Medicine, Seoul, Korea
- 11Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- 12Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
- 13Ewha Womans University College of Medicine, Seoul, Korea
- KMID: 2566754
- DOI: http://doi.org/10.5230/jgc.2025.25.e16
Abstract
- Purpose
Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.
Materials and Methods
We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and metaanalyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Results
Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06–1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21–1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04–1.91).
Conclusions
The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.
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