Heavy alcohol consumption can increase the risk of gastric cancer (both in men and women), while light to moderate alcohol consumptive could decrease this risk (especially in women). Heavy consumption of spirits seems to be associated with the highest risk of gastric cancer. That is the conclusion of three meta-analyses that were recently published in the scientific journal Oncotarget.

What is already known? Previous studies found that mainly heavy alcohol consumption can increase the risk of gastric cancer. Also the World Cancer Research Fund indicates that alcohol consumption (especially heavy consumption) probably increases the risk of gastric cancer. Results on the association with light to moderate alcohol consumption are inconsistent; most studies show a slightly decreased risk, while other studies find no association or even an increased risk.

What do these studies add? These three meta-analyses give more insight in the association between alcohol consumption and gastric cancer. They all use a large number of recent studies. One of the meta-analysis looks at categories of light, moderate and heavy alcohol consumption, while another meta-analysis compares high versus low alcohol intake. A third meta-analysis looks at the level of alcohol intake (in grams per day) and the risk of gastric cancer. One of the meta-analyses also takes different alcoholic beverages into account.

Increased intake, increased risk
The results of these three meta-analyses are difficult to compare and not consistent. However, the results indicate that heavy alcohol consumption increases the risk of gastric cancer1,2,3. This is in line with the conclusion of the World Cancer Research Fund, that more than 45g alcohol per day probably increases the risk of gastric cancer4.
Next to that, there are indications of a J-curve, where moderate alcohol consumption might lower the risk (especially in women)1,2. There also seems to be a difference when drinking beer, wine or spirits. High consumption of spirits is related to the highest risk of gastric cancer3.

Mechanism
Little is known about the mechanism behind the effect of alcohol on gastric cancer, but there are some indications. Heavy alcohol consumption is associated with malnutrition and a decreased intake of fruit, vegetable and other foods with a cancer-preventive effect3. Next to that, the type of alcoholic beverage might play a role in the interaction with the gastric mucosa. Especially heavy alcohol consumption of spirits, with a high alcohol percentage, could damage this mucosa. An increase in damage of the mucosa gives rise to gastric cancer cells2.

Gastric cancer
In 2012, gastric cancer was the fourth most common cancer in Europe and was in the top three of most deaths from cancer5. The number of incident and mortality cases from gastric cancer is slowly decreasing. Previous studies indicated that different lifestyle factors, including alcohol consumption, are associated with the risk of gastric cancer. Smoking, high salt intake, and vitamin C deficiency are mentioned as risk factors6,7. The results of studies looking at the association between alcohol consumption and gastric cancer remain inconsistent8-13.

Strengths of these studies
• The results of the meta-analyses are based on a large number of recent studies.
• Two meta-analyses indicate a dose-response relationship between alcohol consumption and gastric cancer.
• Results for different sub-analyses are described extensively.
• There is no indication of publication bias for all three meta-analyses.

Limitations of these studies
• The three meta-analyses draw no consistent conclusion.n
• The underlying mechanism is still unknown. This could be different for spirits.
• Relatively more men are included in the studies that were used for the meta-analyses. Differences between men and women are therefore difficult to investigate.
• In all three meta-analyses, light to moderate alcohol consumption is associated with a decreased risk of gastric cancer for women. There is no clear explanation for this.

References
1. He Z, Zhao TT, Xu HM, Wang ZN, Xu YY, Song YX, … & Miao ZF. Association between alcohol consumption and the risk of gastric cancer: a meta-analysis of prospective cohort studies. Oncotarget. 2017;8(48):84459.
2. Han X, Xiao L, Yu Y, Chen Y, & Shu HH. Alcohol consumption and gastric cancer risk: a meta-analysis of prospective cohort studies. Oncotarget. 2017;8(47):83237.
3. Wang PL et al. Alcohol drinking and gastric cancer risk: a meta-analysis of observational studies. Oncotarget. 2017;8(58):99013.
4. World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Stomach Cancer. 2016.
5. Ferlay J et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. European Journal of Cancer. 2013;49(6):1374-1403.
6. Ladeiras-Lopes, Ricardo, et al. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes & Control. 2008;19(7):689-701.
7. Tsugane S and Sasazuki S. Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer. 2007;10(2):75-83.
8. Ji J, Sundquist J and Sundquist K. Association of alcohol use disorders with amyotrophic lateral sclerosis: a Swedish national cohort study. European Journal of Neurology. 2016;23(2):270-275.
9. Jayalekshmi PA, Hassani S, Nandakumar A, Koriyama C, Sebastian P, Akiba S. Gastric cancer risk in relation to tobacco use and alcohol drinking in Kerala, India—Karunagappally cohort study. World Journal of Gastroenterology. 2015; 21:12676–12685.
10. Hidaka A, Sasazuki S, Matsuo K, Ito H, Sawada N, Shimazu T, Yamaji T, Iwasaki M, Inoue M, Tsugane S, Group JS. Genetic polymorphisms of ADH1B, ADH1C, ALDH2, alcohol consumption, and the risk of gastric cancer: the Japan Public Health Center-based prospective study. Carcinogenesis. 2015; 36:223–231.
11. de Menezes RF, Bergmann A, de Aguiar SS, Thuler LC. Alcohol consumption and the risk of cancer in Brazil: A study involving 203,506 cancer patients. Alcohol. 2015; 49:747–751.
12. Everatt R, Tamosiunas A, Kuzmickiene I, Virviciute D, Radisauskas R, Reklaitiene R, Milinaviciene E. Alcohol consumption and risk of gastric cancer: a cohort study of men in Kaunas, Lithuania, with up to 30 years follow-up. BMC Cancer. 2012; 12:475.
13. Duell EJ, Travier N, Lujan-Barroso L, Clavel-Chapelon F, Boutron-Ruault MC, Morois S, Palli D, Krogh V, Panico S, Tumino R, Sacerdote C, Quiros JR, Sanchez-Cantalejo E et al. Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. American Journal of Clinical Nutrition. 2011;94:1266–1275.

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