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Epidemiology

Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project

British Journal of Cancer volume 126, pages 1755–1764 (2022)Cite this article

Subjects

Abstract

Background

The role of allium vegetables on gastric cancer (GC) risk remains unclear.

Methods

We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the “Stomach cancer Pooling (StoP) Project”, including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach.

Results

Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56–0.90), with substantial heterogeneity across studies (I2 > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55–0.86) for onions and 0.83 (95% CI, 0.75–0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29–0.86) but not European (OR 0.96, 95% CI, 0.81–1.13) and American (OR 0.66, 95% CI, 0.39–1.11) studies. Results were consistent across all other strata.

Conclusions

In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.

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Fig. 1: Forest plot of allium vegetables consumption and gastric cancer risk.
Fig. 2: Exposure-response relation between allium vegetables consumption and gastric cancer.

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Data availability

The data that support the findings of our study are available from the StoP Project but restrictions apply to the availability of these data, which were used under license for this study and so are not publicly available. Data are, however, available from the authors upon reasonable request and permission of the Steering Committee of the StoP Project.

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Acknowledgements

The authors thank the European Cancer Prevention (ECP) Organization for providing support for the StoP Project meetings and all MCC-Spain study collaborators (CIBERESP, ISCIII, ISGlobal, ICO, University of Huelva, University of Oviedo, University of Cantabria, ibs.Granada, Instituto Salud Pública de Navarra, FISABIO, Murcia Regional Health Authority and cols).

Funding

This study was supported by the Fondazione AIRC per la Ricerca sul Cancro, Project no. 21378 (Investigator Grant), and by the Italian League for the Fight Against Cancer (LILT), which did not play a role in study design, data collection, data analysis, interpretation of the results or in the writing of this manuscript. The Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit; UIDB/04750/2020) was funded by the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education). SM was also funded by the project “NEON-PC—Neuro-oncological complications of prostate cancer: a longitudinal study of cognitive decline” (POCI-01–0145-FEDER-032358; ref. PTDC/SAU-EPI/32358/2017), which is funded by FEDER through the Operational Programme Competitiveness and Internationalisation, national funding from FCT, and the EPIUnit – Junior Research – Prog Financing (UIDP/04750/2020). The Brasilian study was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo-FAPESP number 2014/26897-0 SaoPaulo Brasil.

Author information

Authors and Affiliations

  1. Branch of Medical Statistics, Biometry, and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Michela Dalmartello, Federica Turati, Rossella Bonzi, Georgia Martimianaki, Monica Ferraroni, Eva Negri, Carlo La Vecchia & Claudio Pelucchi

  2. Unit of Medical Statistics and Biometry, National Cancer Institute of Milan, Milan, Italy

    Federica Turati

  3. Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA

    Zuo-Feng Zhang

  4. EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal

    Nuno Lunet & Samantha Morais

  5. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    Nuno Lunet & Samantha Morais

  6. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal

    Nuno Lunet & Samantha Morais

  7. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy

    Matteo Rota

  8. Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy

    Carlotta Galeone

  9. Hellenic Health Foundation, Athens, Greece

    Georgia Martimianaki, Antonia Trichopoulou & Anna Karakatsani

  10. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy

    Domenico Palli

  11. Medical Informatics Center, Peking University, Peking, China

    Guo-Pei Yu

  12. Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Reza Malekzadeh, Mohammadreza Pakseresht & Farhad Pourfarzi

  13. Mexico National Institute of Public Health, Morelos, Mexico

    Lizbeth López-Carrillo

  14. Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia

    David Zaridze & Dmitry Maximovitch

  15. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Nuria Aragonés, Vicente Martin, Jesus Vioque & Manoli Garcia de la Hera

  16. Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain

    Nuria Aragonés

  17. Health Research Institute of Asturias, ISPA and IUOPA University of Oviedo, Oviedo, Spain

    Guillermo Fernández-Tardón

  18. Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain

    Vicente Martin

  19. Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 46020, Alicante, Spain

    Jesus Vioque & Manoli Garcia de la Hera

  20. Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil

    Maria Paula Curado

  21. Department of Abdominal Surgery, A.C.Camargo Cancer Center, São Paulo, SP, Brazil

    Felipe Jose Fernandez Coimbra

  22. Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil

    Paulo Assumpcao

  23. Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada

    Mohammadreza Pakseresht

  24. Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom

    Mohammadreza Pakseresht

  25. Harbin Medical University, Harbin, China

    Jinfu Hu

  26. Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, CT, USA

    Raúl Ulises Hernández-Ramírez

  27. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA

    Mary H. Ward & M. Costanza Camargo

  28. Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran

    Farhad Pourfarzi

  29. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA

    Lina Mu

  30. Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan

    Shoichiro Tsugane & Akihisa Hidaka

  31. National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan

    Shoichiro Tsugane

  32. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Pagona Lagiou

  33. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Pagona Lagiou

  34. Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece

    Areti Lagiou

  35. 2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Haidari, Greece

    Anna Karakatsani

  36. Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA

    Paolo Boffetta

  37. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Paolo Boffetta & Eva Negri

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  1. Michela Dalmartello
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Contributions

MD performed the statistical analysis, interpreted the data and revised the manuscript; FT drafted the manuscript; MR and GM contributed to the statistical analysis; MR, CP, RB and CG harmonised the data, as part of the Stomach Cancer Pooling (StoP) Project; ZFZ, NL, DP, MF, GPY, SM, RM, LLC, DZ, DM, NA, GFT, VM, JV, MGH, MPC, FJFC, PA, MP, JH, RUHR, MW, FP, LM, ST, AH, PL, AL, AT, AK, PB, MCC, EN and CLV supplied the data as part of the StoP Project; CLV and CP supervised the analysis and interpretation of data, and reviewed the manuscript for important intellectual content; CP defined the study hypotheses and designed the investigation, and had primary responsibility for final content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Federica Turati.

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The authors declare no competing interests.

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Not applicable.

Ethics approval and consent to participate

The participating studies were performed in accordance with laws, regulations and guidelines for the protection of human subjects (including consent from the participants) applicable at the time of study conduction, and in accordance with the Declaration of Helsinki. All identifying information was removed before data were pooled at the study coordinating centre located at the University of Milan. The StoP Project received ethical approval from the University of Milan Review Board (reference 19/15 on 01/04/2015).

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Dalmartello, M., Turati, F., Zhang, ZF. et al. Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project. Br J Cancer 126, 1755–1764 (2022). https://doi.org/10.1038/s41416-022-01750-5

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  • DOI: https://doi.org/10.1038/s41416-022-01750-5

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