Carlos A. González, Paula Jakszyn, Guillem Pera, Antonio Agudo, Sheila Bingham, Domenico Palli, Pietro Ferrari, Heiner Boeing, Giuseppe del Giudice, Mario Plebani, Fátima Carneiro, Gabriella Nesi, Franco Berrino, Carlotta Sacerdote, Rosario Tumino, Salvatore Panico, Göran Berglund, Henrik Simán, Olof Nyrén, Göran Hallmans, Carmen Martinez, Miren Dorronsoro, Aurelio Barricarte, Carmen Navarro, José R. Quirós, Naomi Allen, Timothy J. Key, Nicholas E. Day, Jakob Linseisen, Gabriele Nagel, Manuela M. Bergmann, Kim Overvad, Majken K. Jensen, Anne Tjonneland, Anja Olsen, H. Bas Bueno-de-Mesquita, Marga Ocke, Petra H. M. Peeters, Mattijs E. Numans, Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, Antonia Trichopoulou, Theodora Psaltopoulou, Dimitrios Roukos, Eiliv Lund, Bertrand Hemon, Rudolf Kaaks, Teresa Norat, Elio Riboli

 

Affiliations of authors: Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain (CAG, PJ, GP, AA); Medical Research Council Dunn Human Nutrition Unit, Cambridge, United Kingdom (SB); Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy (DP, MMB); German Institute of Human Nutrition, Potsdam–Rehbücke, Germany (HB); IRIS Research Center, Chiron-Vaccines, Siena, Italy (GdG); Servizio di Medicina di Laboratorio, Azienda Ospedaliera di Padova, Padua, Italy (MP); Institute of Molecular Pathology and Immunology of the University of Porto and Medical Faculty, Porto, Portugal (FC); Department of Human Pathology and Oncology, University of Florence, Florence, Italy (G. Nesi); Epidemiology Unit, Istituto Tumori, Milan, Italy (FB); University of Torino, Turin, Italy (CS); Cancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo,” Ragusa, Italy (RT); Dipartamento di Medicina Clinica e Sperimentale, Federico II University, Compagnia di San Paolo, Naples, Italy (SP); Department of Medical Epidemiology, Karolinska Instututet, Stockholm, Sweden (GB, HS); Department of Nutritional Research, University of UmeÃ¥, UmeÃ¥, Sweden (ON, GH); Andalusian School of Public Health, Granada, Spain (CM); Department of Public Health of Guipuzkoa, San Sebastian, Spain (MD); Public Health Institute of Navarra, Pamplona, Spain (AB); Epidemiology Department, Health Council of Murcia, Murcia, Spain (CN); Public Health and Health Planning Directorate, Asturias, Spain (JRQ); Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom (NA, TJK); Strangeways Research Laboratory, Cambridge, United Kingdom (NED); Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany (JL, G. Nagel); Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (KO, MJK); Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (AT, AO); Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (HBBdM, MO); Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands (PHMP, MEN); INSERM, Institut Gustave Roussy, Villejuif, France (FC-C, M-CB-R); Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece (AT, TP); University of Ioannina, Medical School, University of Athens, Athens, Greece (DR); Institute of Community Medicine, University of Tromso, Tromso, Norway (EL); Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France (PF, BH, RK, TN, ER)

 

Correspondence to: Carlos A. González, MD, PhD, Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain (e-mail: cagonzalez@ico.scs.es

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Background: Dietary factors are thought to have an important role in gastric and esophageal carcinogenesis, but evidence from cohort studies for such a role is lacking. We examined the risks of gastric cancer and esophageal adenocarcinoma associated with meat consumption within the European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort. Methods: A total of 521 457 men and women aged 35–70 years in 10 European countries participated in the EPIC cohort. Dietary and lifestyle information was collected at recruitment. Cox proportional hazard models were used to examine associations between meat intake and risks of cardia and gastric noncardia cancers and esophageal adenocarcinoma. Data from a calibration substudy were used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. In a nested case–control study, we examined interactions between Helicobacter pylori infection status (i.e., plasma H. pylori antibodies) and meat intakes. All statistical tests were two-sided. Results: During a mean follow-up of 6.5 years, 330 gastric adenocarcinoma and 65 esophageal adenocarcinomas were diagnosed. Gastric noncardia cancer risk was statistically significantly associated with intakes of total meat (calibrated HR per 100-g/day increase = 3.52; 95% CI = 1.96 to 6.34), red meat (calibrated HR per 50-g/day increase = 1.73; 95% CI = 1.03 to 2.88), and processed meat (calibrated HR per 50-g/day increase = 2.45; 95% CI = 1.43 to 4.21). The association between the risk of gastric noncardia cancer and total meat intake was especially large in H. pylori-infected subjects (odds ratio per 100-g/day increase = 5.32; 95% CI = 2.10 to 13.4). Intakes of total, red, or processed meat were not associated with the risk of gastric cardia cancer. A positive but non–statistically significant association was observed between esophageal adenocarcinoma cancer risk and total and processed meat intake in the calibrated model. In this study population, the absolute risk of development of gastric adenocarcinoma within 10 years for a study subject aged 60 years was 0.26% for the lowest quartile of total meat intake and 0.33% for the highest quartile of total meat intake. Conclusion: Total, red, and processed meat intakes were associated with an increased risk of gastric noncardia cancer, especially in H. pylori antibody-positive subjects, but not with cardia gastric cancer.

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