Nitrosamine intake and gastric cancer risk

The association between intake of N-nitrosodimethylamine (NDMA), the most commonly occurring of the volatile nitrosamines derived from foods, and gastric cancer risk has been investigated using data from a case-control study conducted in Northern Italy between 1985 and 1993, including 746 incident cases of gastric cancer and 2,053 controls admitted to hospital for acute, non-neoplastic and non-digestive tract diseases, not related to long-term modifications of diet. Information was collected on frequency of consumption of 29 food items, including selected sources of NDMA. Compared with subjects in the lowest tertile of NDMA intake, the odds ratios (ORs) were 1.1 in the intermediate and 1.6 in the highest tertile of intake. These estimates were not appreciably modified after allowance for total energy intake, other major dietary and non-dietary correlates of gastric cancer, and estimated intake of nitrite and nitrate: the multivariate OR for the highest NDMA intake tertile was 1.4 (95% CI 1.1-1.7). The association was consistent across strata of sex and age, but somewhat stronger in males and in subjects below age 60 (OR in the highest tertile, 1.8). Limitations of exposure assessment and absence of information on other N-nitrosamines preclude, however, any definite assessment of the possible role of exogenous N-nitrosamines in gastric carcinogenesis.