Poorer prognosis; affects

Predominant in high-risk

younger age groups

geographic regions

been associated with an increased risk of gastric cancer.

Dietary factors have been studied extensively, but results from various studies are inconsistent. There is an inverse relationship between the intake of vegetables and fruit and the risk of gastric cancer. Other food items such as processed meat and fish, milk, and salt have given inconsistent results. Vitamin C has been seen to be protective in observational studies in China, Italy, and Sweden, while results on tocopherol are contradictory. Vitamin A does not seem to have any effect on risk of cancer of the stomach; however, most reports indicate that beta-carotene, a vitamin A precursor, appears to be protective. Studies on protein, carbohydrate, fat, dietary fiber, and calcium have conflicting results. At the population level, dietary nitrate exposure has been correlated with risk of gastric cancer. Case-control studies on nitrate and nitrite consumption do not support their proposed role in carcinogenesis, probably because of the difficulty in measuring their levels in food constituents. It has been suggested that he decline in incidence of stomach cancer may be due to a reduction in salt intake and a departure from traditional food preservation practices such as salting and pickling with the advent of refrigeration.

Helicobacter pylori are Gram-negative, curved bacteria that live in the mucus layer of the stomach (see below). These bacteria cause a chronic infection, which results in long-standing inflammation. Infection with H. pylori is prevalent in populations with a high risk of gastric carcinoma. A recent study showed that the incidence and mortality rates of gastric cancer were associated with the prevalence of H. pylori seropositivity in 17 populations. However, there are populations (e.g., in Africa) where H. pylori is prevalent at young ages but gastric cancer is uncommon. Therefore, the role of H. pylori in the pathogenesis of cancer needs further clarification.

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