Fruit, Vegetables, and Stomach Cancer Risk

 

Review of Ann Epidemiol 2003;13(1):24-31.

A recent study published in the journal Annals of Epidemiology examined several dietary factors and risk of gastric (stomach) cancer. This article reviews this study. The study indicates that eating more vegetables and fruits decreases risk of stomach cancer. We provide PRACTICAL information on what this study means. We explain which specific foods and nutrients appear to most decrease risk of stomach cancer. Most importantly, we provide ideas for using this information in a dietary plan to reduce stomach cancer risk. Factors such as past use of tobacco and alcohol, age, and genetics cannot be changed, but diet and nutrition can! This type of information will allow people to take concrete and practical steps to decrease their risk of stomach cancer.

Note: Numbers appearing at the end of sentences indicate research references. References are listed at the end of each article.

Background

As early as the 1960s, researchers were studying how diet might be linked to stomach cancer (1-4). Some common risk factors for stomach cancer include infection with a type of bacteria called helicobacter pylori (H. pylori) and use of tobacco and alcohol (smoking and drinking) (5-8). However, even for people who have H. pylori bacteria in their stomach or people who have a history of tobacco and alcohol use, certain types of diet may increase or decrease risk of stomach cancer. Recent research tells us that plant foods, especially fruits and vegetables, can greatly decrease risk of stomach cancer (6,9-26). This has led to interest in determining which specific foods and nutrients might protect against stomach cancer. A study published in the journal Annals of Epidemiology looked at several dietary factors and risk of stomach cancer (27). It is hoped this research will identify dietary factors that increase or decrease stomach cancer risk. Factors such as past use of tobacco and alcohol, age, and genetics cannot be changed, but diet and nutrition can! This type of information will allow people to take concrete and practical steps to decrease their risk of stomach cancer.

What The Study Found

For this study (27), 508 Japanese women with stomach cancer and 36,490 Japanese women without stomach cancer were asked about their diet. Information on other lifestyle factors was collected and accounted for in the study. Researchers classified the women regarding the amounts and types of foods they had eaten in the past. Researchers used this information to examine whether eating certain foods and nutrients was related to having a history of stomach cancer. Two important results came out of this study. 

First, the researchers found that women who ate raw vegetables at least once daily had only HALF the risk of stomach cancer when compared to women who ate raw vegetables rarely. In other words, eating raw vegetables daily reduced risk of stomach cancer by HALF. In particular, researchers found that green vegetables and carrots were most protective against stomach cancer.

Second, the study showed that women eating fruit at least once daily reduced their risk of a specific type of stomach cancer (differentiated type) by over 70% when compared to women who ate fruit rarely. In other words, eating fruit was protective against this type of stomach cancer. 

What do these results mean?

The results of this study may or may not apply to people living in countries other than Japan. First, it is important to note that there are MANY differences in diet and lifestyle between Japanese and non-Japanese people. Another difference between people living in Japan and those not living in Japan is H. pylori bacteria. Remember that this is a bacteria that increases risk of stomach cancer. Infection with H. pylori is more common in Japan than in many other parts of the world, including the United States. This means stomach cancer is more common in Japan than in many parts of the world. Even with these differences, it is reassuring that studies in numerous other countries, including the United States, have shown that eating more vegetables and fruit may help protect against stomach cancer (6,10-12,14,15,18-22). This means that even though this study (27) was conducted in Japan, the results probably apply to other people as well.

How can I change my diet to reduce my stomach cancer risk?

What should you do to help reduce your risk of stomach cancer? First, remember that there are MANY cancer-fighting diet changes you can make. This study (27) tells us that a good place to start is with vegetables and fruit. According to this research, increasing the amount of fresh vegetables and fruit you eat can decrease stomach cancer risk. In particular, try to focus on eating more dark green vegetables, carrots, and other orange-yellow vegetables and fruit. You should make it a goal to eat at least 3-5 servings of vegetables and 2-4 servings of fruit every day. This means you should be eating a minimum of 5 servings (3 veggies + 2 fruits) of these foods per day. If you eat the maximum recommended amount of 5 vegetables and 4 fruits, you can get in NINE servings per day!

What if I don't eat any of these foods right now?

Even if you don't eat vegetables and fruit every day, don't be discouraged. The research tells us that even adding in one or two servings of these foods each day can decrease stomach cancer risk! It's never too late to start  making these healthy changes. 

If eating the recommended 5 to 9 servings of vegetables & fruits per day seems overwhelming, start with small changes and work up to the goal of 5 to 9 serving slowly, over time. Remember, this is just an average amount of these foods you should eat. If you eat less on one day, try to get in an extra serving the next day. It all counts and a serving may be less than you think. Five to nine sounds like a lot of these foods, but a serving is not very big.

What is a serving of vegetables?  

  • 1 cup, loosely packed raw green leafy vegetables or 1/2 cup cooked greens
  • 1/2 cup chopped any other vegetable, cooked
  • A handful of baby carrots (5-7)
  • 6 oz vegetable juice 

What is a serving of fruit?

  • 1 medium apple, banana, or orange
  • 1 melon wedge
  • 1/4 to 1/2 cup berries or chopped fruit
  • 1 to 2 oz dried fruit (a small handful)
  • 3/4 cup fruit juice - this is 6 oz of 100% fruit juice, NOT fruit drink

Other Important Points to Remember

  • Focus on variety. Don't get stuck in the rut of eating the same foods over and over. At least one study tells us that eating a WIDE VARIETY of vegetables and fruit will reduce stomach cancer risk (28).
  • Focus on the nutrition powerhouses! Most people eat the same, boring vegetables and fruit over and over. Researchers have determined that the brightly colored vegetables and fruit give more bang for the buck (15). These foods are loaded with healthy phytochemicals. If the food is brightly colored (green, yellow, red, orange, purple, blue), it contains more cancer fighting nutrients. Get out of that rut and try some new foods. Frozen produce works just as well as fresh!
  • DO NOT rely only on supplements to reduce your cancer risk!! Researchers have found out that just taking a pill of a few of the nutrients that are in plants, such as beta-carotene (found in carrots) does not reduce risk as well as eating the food itself (29)! Just because a food or type of diet fights cancer, does not always mean that taking a pill with a few of the same nutrients will do the same thing. Focus On Food First. Use a supplement to 'supplement' your healthy lifestyle.

Recipes to Help You Eat a Plant Based Diet

Sweet Spicy Kale

Sweet Potato Lentil Soup

NOTE: If you are in cancer treatment, these diet changes may not be right for you. 

References

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2. Hakama M, Saxen EA. Cereal consumption and gastric cancer. Int J Cancer. 1967;2(3):265-68.

3. MacDonald WC. Gastric cancer among the Japanese of British Columbia: dietary studies. Proc Can Cancer Conf. 1966;6:451-59.

4. Kmet J. The relationship between diet and stomach cancer in Yugoslavia. Cancro. 1966;19(2):163-71.

5. Sasazuki S, Sasaki S, Tsugane S; Japan Public Health Center Study Group. Cigarette smoking, alcohol consumption and subsequent gastric cancer risk by subsite and histologic type. Int J Cancer. 2002;101(6):560-66.

6. Lee SA, Kang D, Shim KN, Choe JW, Hong WS, Choi H. Effect of diet and Helicobacter pylori infection to the risk of early gastric cancer. J Epidemiol. 2003;13(3):162-68.

7. Xia HH, Wong BC, Lam SK. Chemoprevention of gastric cancer: current status. Chin Med J (Engl). 2003;116(1):5-10.

8. Chao A, Thun MJ, Henley SJ, Jacobs EJ, McCullough ML, Calle EE. Cigarette smoking, use of other tobacco products and stomach cancer mortality in US adults: The Cancer Prevention Study II. Int J Cancer. 2002;101(4):380-89.

9. Sauvaget C, Nagano J, Hayashi M, Spencer E, Shimizu Y, Allen N. Vegetables and fruit intake and cancer mortality in the Hiroshima/Nagasaki Life Span Study. Br J Cancer. 2003;88(5):689-94.

10. Cai L, Zheng ZL, Zhang ZF. Risk factors for the gastric cardia cancer: a case-control study in Fujian. Province. World J Gastroenterol. 2003;9(2):214-18.

11. Gonzalez CA; EPIC Working Group on Gastric Cancer. Vegetable, fruit and cereal consumption and gastric cancer risk. IARC Sci Publ. 2002;156:79-83.

12. Mayne ST, Navarro SA. Diet, obesity and reflux in the etiology of adenocarcinomas of the esophagus and gastric cardia in humans. J Nutr. 2002;132(11 Suppl):3467S-70S.

13. Hamada GS, Kowalski LP, Nishimoto IN, Rodrigues JJ, Iriya K, Sasazuki S, Hanaoka T, Tsugane S; Sao Paulo--Japan Cancer Project Gastric Cancer Study Group. Risk factors for stomach cancer in Brazil (II): a case-control study among Japanese Brazilians in Sao Paulo. Jpn J Clin Oncol. 2002;32(8):284-90.

14. Nishimoto IN, Hamada GS, Kowalski LP, Rodrigues JG, Iriya K, Sasazuki S, Hanaoka T, Tsugane S; Sao Paulo--Japan Cancer Project Gastric Cancer Study Group. Risk factors for stomach cancer in Brazil (I): a case-control study among non-Japanese Brazilians in Sao Paulo. Jpn J Clin Oncol. 2002;32(8):277-83.

15. Serafini M, Bellocco R, Wolk A, Ekstrom AM. Total antioxidant potential of fruit and vegetables and risk of gastric cancer. Gastroenterology. 2002;123(4):985-91.

16. Kobayashi M, Tsubono Y, Sasazuki S, Sasaki S, Tsugane S; JPHC Study Group. Vegetables, fruit and risk of gastric cancer in Japan: a 10-year follow-up of the JPHC Study Cohort I. Int J Cancer. 2002;102(1):39-44.

17. Terry MB, Gaudet MM, Gammon MD. The epidemiology of gastric cancer. Semin Radiat Oncol. 2002;12(2):111-27.

18. La Vecchia C, Altieri A, Tavani A. Vegetables, fruit, antioxidants and cancer: a review of Italian studies. Eur J Nutr. 2001;40(6):261-67.

19. Takezaki T, Gao CM, Wu JZ, Ding JH, Liu YT, Zhang Y, Li SP, Su P, Liu TK, Tajima K. Dietary protective and risk factors for esophageal and stomach cancers in a low-epidemic area for stomach cancer in Jiangsu Province, China: comparison with those in a high-epidemic area. Jpn J Cancer Res. 2001;92(11):1157-65.

20. McCullough ML, Robertson AS, Jacobs EJ, Chao A, Calle EE, Thun MJ. A prospective study of diet and stomach cancer mortality in United States men and women. Cancer Epidemiol Biomarkers Prev. 2001;10(11):1201-05.

21. Mayne ST, Risch HA, Dubrow R, Chow WH, Gammon MD, Vaughan TL, Farrow DC, Schoenberg JB, Stanford JL, Ahsan H, West AB, Rotterdam H, Blot WJ, Fraumeni JF Jr. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev. 2001;10(10):1055-62.

22. De Stefani E, Correa P, Boffetta P, Ronco A, Brennan P, Deneo-Pellegrini H, Mendilaharsu M. Plant foods and risk of gastric cancer: a case-control study in Uruguay. Eur J Cancer Prev. 2001;10(4):357-64.

23. La Vecchia C, Franceschi S. Nutrition and gastric cancer. Can J Gastroenterol. 2000;14(Suppl D):51D-54D.

24. Palli D. Epidemiology of gastric cancer: an evaluation of available evidence. J Gastroenterol. 2000;35(Suppl 12):84-89.

25. La Vecchia C, Tavani A. Fruit and vegetables, and human cancer. Eur J Cancer Prev. 1998;7(1):3-8.

26. Galanis DJ, Kolonel LN, Lee J, Nomura A. Intakes of selected foods and beverages and the incidence of gastric cancer among the Japanese residents of Hawaii: a prospective study. Int J Epidemiol. 1998;27(2):173-80.

27. Ito LS, Inoue M, Tajima K, Yamamura Y, Kodera Y, Hirose K, Takezaki T, Hamajima N, Kuroishi T, Tominaga S. Dietary factors and the risk of gastric cancer among Japanese women: a comparison between the differentiated and non-differentiated subtypes. Ann Epidemiol. 2003;13(1):24-31.

28. La Vecchia C, Munoz SE, Braga C, Fernandez E, Decarli A. Diet diversity and gastric cancer. Int J Cancer. 1997;72(2):255-57.

29. Malila N, Taylor PR, Virtanen MJ, Korhonen P, Huttunen JK, Albanes D, Virtamo J. Effects of alpha-tocopherol and beta-carotene supplementation on gastric cancer incidence in male smokers (ATBC Study, Finland). Cancer Causes Control. 2002;13(7):617-23.

Publish Date: 10/2003

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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