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The influence of dietary habits on what does equivalent fractions mean math goodies development of gastric adenocarcinoma is not clear. The objective of the present study was to explore the association of three previously identified dietary patterns with gastric adenocarcinoma by sex, age, cancer site, and morphology. MCC-Spain is a multicase—control study that included incident cases of gastric adenocarcinoma and controls.
The association of the Western, Prudent, and Mediterranean dietary patterns—derived what does equivalent fractions mean math goodies another Spanish case—control study—with gastric adenocarcinoma was assessed using multivariable logistic regression models with random province-specific intercepts and considering a possible interaction with sex and age. Although no significant heterogeneity of effects was observed, the harmful effect of the Western pattern was stronger among older participants and for non-cardia adenocarcinomas, whereas the protective effect of the Mediterranean pattern was only observed among younger participants and for non-cardia tumors.
Decreasing the what is a shot list in photography of fatty and sugary products and of red and processed meat in favor of an increase in the intake of fruits, vegetables, legumes, what does equivalent fractions mean math goodies oil, nuts, and fish might prevent gastric adenocarcinoma.
Although age-standardized incidence rates of gastric cancer GC have decreased globally during the past decades, this tumor continues to be the fifth most often diagnosed worldwide, and the absolute number of new cases has increased what does equivalent fractions mean math goodies nearly 1. Also, because of its poor survival rates, GC ranks third in mortality what does equivalent fractions mean math goodies [ 1 ].
Therefore, in the following years, cancer prevention efforts should be as important as related delivery of care. Even though the global burden of GC that is attributable to Helicobacter pylori H. In the past decades some authors have argued that the lack of conclusive associations between diet and some diseases might be because the effects of foods and nutrients are usually explored individually [ 789 ], and they suggest that dietary pattern analysis would be more adequate because it allows exploration of the effect of food and nutrient interactions in disease [ 789 ].
The EpiGEICAM study presents the novelty of being able to identify, with data-driven statistical methods and over a single population, two patterns that are commonly interchanged in the related literature Prudent and Mediterranean. According to this study, these two patterns represent two diets with different characteristics that might be determinant in their association with disease risk [ 12 ].
We believe that the application of these patterns in different populations and what does equivalent fractions mean math goodies exploration of their association with tumors other than BC are of great scientific interest. In fact, these patterns have already been applied over an independent sample, and the reproducibility of the results obtained in EpiGEICAM has been assessed for breast [ 13 ] and prostate cancer [ 14 ].
The objective of the present study is to assess the reproducibility of the associations found between a high adherence to the Western, Prudent, what does equivalent fractions mean math goodies Mediterranean dietary patterns and BC risk in our country, with gastric adenocarcinoma GAC by sex, age, cancer site, and morphology. The multicase—control study MCC-Spain [ 15 ] was conducted with the objective of identifying environmental, demographic, anthropometric, lifestyle, and genetic factors related to five common cancers: breast, prostate, colorectal, gastric, and chronic lymphocytic leukemia.
A single set of population-based controls, frequency matched by age and sex with the overall distribution of cases in each province, was randomly selected from the list of residents assigned to selected primary care health centers located within the catchment what does equivalent fractions mean math goodies of each of the collaborating hospitals. Controls were contacted by phone, and those who agreed to participate attended a personal interview.
The detailed selection process of GC cases and controls has been previously described elsewhere [ 1516 ]. Briefly, participants able to answer the questionnaire, who had lived in the study area for at least 6 months before the diagnosis, and were 20—85 years old were invited to participate. Cases were identified, as soon as possible after their diagnosis, through active search that included periodic visits to the collaborating hospital departments.
Histologically confirmed incident cases of GC codes C malignant neoplasm of stomach; D Classification into cardia and non-cardia gastric cancer cases was done according to the information available in the medical records. Controls were randomly selected from general practitioner lists in the same areas. All participants were informed about the study objectives and signed an informed consent. Missing values on key variables and specific questions on additional study objectives were completed through subsequent telephone contact.
Height and weight at different can food cause dementia were self-reported, and diet was assessed with a item semi-quantitative food frequency questionnaire FFQwhich was based on a validated instrument in Spain [ 19 ] modified to include regional products. Dietary information referred to the previous year before diagnosis in cases and before interview in controls.
After describing the sample with basic descriptive statistics, adjusted associations between adherence to each dietary pattern and GAC risk were evaluated using logistic regression models with random province-specific intercepts. Scores of adherence were analyzed both as categorical grouping the scores of adherence into quartiles of their distribution among controls and continuous 1-standard deviation increase taking into account the dispersion among controls variables.
Because including data on H. The results from five models were compared. Model 1 included only the province of residence as a random effect; Model 2 was adjusted what does equivalent fractions mean math goodies all the potential confounders except H. Model 4 was adjusted by all potential confounders, including H. The direction of the associations found was similar for all the analyses, and the conclusions of the study did not differ among modeling strategies except for the power of the study to detect statistically significant estimations.
Differences found between models with and without H. Taking this into account, and to keep the maximum statistical power for further estimations, we decided to select the modeling strategy from Model 2 for all the analyses included in Tables 3 and 4. Multinomial logistic regression models were used to evaluate the association of the adherence to the Western, Prudent, and Mediterranean dietary patterns with GAC by location cardia and non-cardia and morphology intestinal and diffuse. Confidence intervals for the PAF were computed using bootstrap with iterations.
Initially, controls and cases of GC were recruited. Therefore GAC cases and controls aged 23—85 years were included in the present study. Compared to controls, GAC cases showed a higher adherence to the three dietary patterns and reported higher energy and alcohol intake than controls in the univariable analyses. The proportion of males was higher among GAC cases that were also older and reported lower levels of physical activity and formal education Table 2.
Table 3 summarizes the adjusted ORs for the association between GAC incidence and the scores of adherence to Western, Prudent, and Mediterranean dietary patterns, for the whole sample and stratified by sex and age. Although no clear effect was observed between GAC and the adherence to the Prudent dietary pattern, a high adherence to the Mediterranean dietary pattern seems to have a considerable protective effect against this tumor, with a significant linear trend.
Participants in the highest category of adherence to the Mediterranean dietary pattern compared to those in the lowest category had an odds ratio of what does equivalent fractions mean math goodies GAC of 0. The positive trend found for the Western dietary what insects are best to eat and the inverse trend found for the Mediterranean dietary pattern in the overall analyses was also observed by tumor location and morphology Table 4.
No clear differences were observed regarding tumor morphology. The associations between Western and Mediterranean patterns were very similar in both intestinal and diffuse tumors. Our results suggest that a high adherence to the Western dietary pattern might increase the risk of developing GAC even for low adherence, and that high adherence to the Mediterranean dietary pattern could prevent GAC. What does the term food pyramid mean is also highlighted that the Prudent pattern, in spite of sharing some characteristics with the Mediterranean diet, has no clear effect on GAC risk.
Our data also point out to a possible stronger effect what does equivalent fractions mean math goodies the Western pattern among older participants and for non-cardia tumors and a larger influence of the Mediterranean pattern on males, younger participants, and for non-cardia tumors, even though tests of heterogeneity were not statistically significant.
The first one usually loads high in red and processed meat, sweets, soft drinks, high-fat dairy, fast food, and sauces and is positively associated with GC risk [ 262728 ]. Only three of these studies explored differences by tumor location [ 2627 ] or morphology [ 2631 ]. Unfortunately, the sample size of the present study did not allow the exploration what does equivalent fractions mean math goodies a possible interaction between dietary patterns and sex by tumor location. Regarding tumor morphology, although Bastos et al.
However, none of the authors provide assessment of the statistical significance of the differences declared. In our case, we believe that the greater sample size of the non-cardia and intestinal tumor subtypes might be related to the greater significance of the associations found for these subgroups. Some biological mechanisms support the plausibility of the associations found. The Western pattern includes a high consumption of red and processed meat, which contributes to the generation of N -nitroso compounds that are suspected mutagens and carcinogens [ 35 ].
Additionally, cooking and processing meat at high temperatures might also contribute to the production of polycyclic aromatic hydrocarbons, which are well-known carcinogens [ 36 ]. The iron present in these types of meat might also induce free radicals, which cause DNA double-strand breaks and oncogene activation [ 37 ].
The purpose of cause and effect diagram addition, the saturated fats that can be found in fast food, sauces, and desserts, also included in the Western diet, can induce expression of certain what does aa mean money wise mediators associated with carcinogenesis [ 38 ].
Regarding the Mediterranean pattern, the high content of antioxidants in fruits and vegetables might be a partial cause of the protective effect of the Mediterranean diet. Antioxidants quench free radicals, reduce oxidative damage to DNA, and intervene in various cancer-related biological pathways such as carcinogen bio-activation, cell signaling, cell-cycle regulation, angiogenesis, and inflammation [ 3940 ]. Additionally, Allium vegetables, particularly garlic, can reduce the severity of H.
Moreover, omega-3 polyunsaturated fatty acids, present in fish and nuts, may have preventive effects by influencing multiple targets implicated in various stages of cancer development, including cell proliferation, cell survival, angiogenesis, inflammation, and metastasis [ 42 ]. Recall bias is always a concern in case—control studies, especially when evaluating the effect of self-reported dietary information.
Anticipating the existence of this bias, some questions about general dietary habits were included in the questionnaire and used to adjust the responses to the FFQ [ 43 ]. To minimize even more the effect of this possible bias, only cases that responded to the questionnaire within the 6 months following the diagnosis were included. Participating controls might have better lifestyles, resulting in an overestimation of the effects. We believe it is unlikely that the effect of this bias is selective and affects only some associations.
Finally, results were not adjusted by data on H. However, the sensitivity analyses carried out Table S1 from Online Resource 1 showed no important differences in the estimation of not to exceed meaning in hindi effects when taking this factor into account, thus supporting the reported associations between diet and GAC as being independent of H. One of the strengths of the current research is the recruitment of histologically confirmed incident cases of GC and population-based controls.
Additionally, the reproducibility [ 23 ] and applicability [ 22 ] of the data-driven dietary patterns found in the EpiGEICAM study [ 12 ] were methodologically tested in two recent studies [ 2223 ]. These studies concluded that similar patterns can be found in independent samples [ 23 ] and that scores of adherence to data-driven dietary patterns can be calculated following the exact same rules over different populations, resulting in different levels of adherence but still being valid [ 22 ].
Furthermore, the sample size allowed the evaluation of potential interactions of diet with sex and age and the exploration of the associations by tumor location and morphology. Finally, the inclusion of cases and controls recruited from ten provinces from the north, south, center, west, and east of the country ensured the representation of the different diets coexisting within Spain.
The dietary variability of the participants allowed the differentiation of the effect of two very similar patterns on GAC risk. Prudent and Mediterranean dietary patterns are commonly interchanged in the literature of data-driven dietary patterns, but they showed different effects on GAC in our study, adding novel information about the association of the so-called healthy dietary habits and GAC. In addition, if our results showing a lack of protective effect of the Prudent pattern on GAC risk are confirmed, the sizes of effects estimated for the Mediterranean pattern in studies that have not differentiated it from the Prudent pattern could be underestimations of the true protective role of the Mediterranean diet.
A high consumption of fruits, vegetables, and whole grains together with a restriction of dietary fat is not enough to prevent GAC. The risk of this tumor might be reduced in the general population by providing dietary recommendations based on decreased consumption of high-fat dairy products, red and processed meat, refined grains, sweets, caloric drinks, convenience foods, and sauces in favor of an increase in the intake of fruits, vegetables, legumes, olive oil, nuts, and fish.
Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, to a systematic analysis for the global burden of disease study. JAMA Oncol. Google Scholar. Global burden of gastric cancer attributable to Helicobacter pylori. Int J Cancer. Gastric cancer: epidemiology and risk factors. Gastroenterol Clin N Am.
Article Google Scholar. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Prev Biomark. The fractions of cancer attributable to modifiable factors: a global review. Cancer Epidemiol. Barkoukis H. Importance of understanding food consumption patterns.
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