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Dietary Factors Associated With the Progression of Gastric Intestinal Metaplasia: A Multicenter, Prospective Cohort
N E A Kapteijn1, F E Marijnissen1, J K F Pluimers1
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Introduction:
Although several dietary factors such as high salt intake are linked to progression of gastric intestinal metaplasia (GIM) to gastric cancer (GC) in high-risk countries, their effect on GIM progression in Western populations remains less clear. This study investigates the influence of dietary factors on GIM progression in a Western population.
Methods:
The PROgression and REgression of precancerous GAstric Lesions (PRORGAL) study (2009-2024) is a prospective cohort study of GIM patients undergoing surveillance. The operative link on GIM criteria determined GIM stage, with an increase in operative link on GIM stage reflecting disease progression. Data on family history, medication use, and diet were collected through self-reported questionnaire and by medical records. Multivariate logistic regression was used to identify risk factors of disease progression.
Results:
A total of 312 GIM patients were included (median age 61 years, 50.3% men, median follow-up 54 months, IQR 36). Progression occurred in 112 patients (35.9%), with 6 patients (1.9%) developing high-grade dysplasia or GC. High dietary salt consumption (OR 1.67; 95% CI 1.05-2.68, P = 0.04), meat ≥6 servings per week (OR 1.25; 95% CI 1.07-1.46, P = 0.004) smoking (OR 1.76; 95% CI 1.04-2.68), autoimmune gastritis (OR 2.49; 95%CI 1.04-5.83) and having a positive first-degree family member with GC (OR 2.01; 95%CI 1.20-3.52) were significantly associated with GIM progression. Fish consumption, alcohol intake, and previous Helicobater pylori infection showed no significant association with GIM progression.
Discussion:
Increased consumption of meat and salt is significantly associated with GIM progression, suggesting that dietary risk factors of GIM progression are similar in low-incidence and high-incidence countries.
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