Graduate Program of A.C.Camargo Cancer Center, São Paulo, Brazil.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
BMC Med. 2024 Nov 28;22(1):562. doi: 10.1186/s12916-024-03785-2.
The causal pathway between different dietary patterns (DPs) and gastric adenocarcinoma (GA) remains largely unexplored. The study aimed to identify DPs and evaluate how selected nutrients mediate the relationship between DPs and GA.
This multicenter case-control study in Brazil involved 1751 participants (600 cases, 377 endoscopic controls, and 774 hospital controls). DPs were identified through exploratory factor analysis. A counterfactual-based mediation analysis was performed to decompose the total effect of DPs on GA into direct and indirect effects mediated by saturated fatty acids, added sugars, total fiber, and sodium intakes. Effects were expressed as ORs and 95% CIs.
Two DPs were identified-"unhealthy dietary pattern" (UDP) and "healthy dietary pattern" (HDP), which were associated with an increased and decreased risk of GA, respectively. Added sugars partly mediated the association between UDP and GA (percentage mediated between 7.3 and 21.7%), while sodium intake mediated most of the association between HDP and GA (percentage mediated between 52.4 and 100%). No significant mediating effects were detected for saturated fatty acids and total fiber.
This study contributes innovative insights into the DPs-GA relationships, highlighting the significant mediating roles of sodium and added sugars, offering valuable information for preventive strategies and public health interventions targeting GA.
不同的饮食模式（DPs）与胃腺癌（GA）之间的因果关系在很大程度上仍未得到探索。本研究旨在确定 DPs，并评估选定的营养素如何在 DPs 与 GA 之间的关系中发挥中介作用。
本研究在巴西进行了一项多中心病例对照研究，共纳入了 1751 名参与者（600 例病例、377 例内镜对照和 774 例医院对照）。通过探索性因子分析确定 DPs。采用基于反事实的中介分析来分解 DPs 对 GA 的总效应为直接效应和由饱和脂肪酸、添加糖、总纤维和钠摄入量介导的间接效应。效应表示为 OR 和 95%CI。
确定了两种 DPs-"不健康的饮食模式"（UDP）和"健康的饮食模式"（HDP），它们分别与 GA 风险的增加和降低相关。添加糖部分介导了 UDP 与 GA 之间的关联（介导比例在 7.3%至 21.7%之间），而钠摄入量介导了 HDP 与 GA 之间的大部分关联（介导比例在 52.4%至 100%之间）。饱和脂肪酸和总纤维没有检测到显著的中介作用。
本研究为 DPs-GA 关系提供了创新的见解，强调了钠和添加糖的重要中介作用，为针对 GA 的预防策略和公共卫生干预措施提供了有价值的信息。
