Gastric Cancer Prevention: Dietary Recommendations
To prevent gastric cancer, it is recommended to avoid salt and salt-preserved foods (Answer D). This recommendation is supported by the strongest evidence from multiple international guidelines and is the most practical dietary modification for gastric cancer prevention.
Primary Evidence for Salt Avoidance
The American Cancer Society explicitly recommends avoiding high salt intake and salt-preserved foods to prevent gastric cancer, along with consuming at least five servings of fruits and vegetables daily. 1
The Maastricht IV/Florence Consensus Report establishes that while H. pylori infection is the most consistent risk factor for gastric cancer, environmental factors including diet play a subordinate but important role. 2 High salt consumption has been identified as a key dietary risk factor across multiple guidelines. 2
Mechanisms of Salt-Induced Carcinogenesis
Salt promotes gastric cancer through several pathways:
- High salt intake disrupts the gastric mucosal defense barrier, promoting H. pylori colonization and penetration of other carcinogenic compounds. 3
- Salt directly damages gastric mucosa, improving temporary epithelial proliferation and increasing the incidence of endogenous mutations. 4
- Salt intake correlates with H. pylori infection rates, and these two factors act synergistically to promote gastric cancer development. 1, 4
- Salt causes hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer. 4
Epidemiological Evidence
The evidence supporting salt avoidance is robust:
- Ecological studies show average salt intake in populations is closely correlated with gastric cancer mortality. 2, 4
- Case-control studies indicate a moderate to high increase in risk for the highest level of salt or salted food consumption. 4
- Prospective cohort studies demonstrate a dose-dependent positive association between salt intake and gastric cancer risk, particularly in men. 5
- A comprehensive meta-analysis of longitudinal studies detected a strong adverse effect of total salt intake and salt-rich foods on gastric cancer risk. 6
Why the Other Options Are Incorrect
Acetaminophen (Option A) has no established association with gastric cancer risk and is not mentioned in any gastric cancer prevention guidelines. 2
Avoiding protein (Option B) is not recommended. In fact, the concern is with specific protein sources: processed meats, red meat, and salt-preserved protein foods increase risk, but protein itself is not contraindicated. 3
Increasing carbohydrates (Option C) is not a prevention strategy. The focus should be on whole grains, fruits, and vegetables rather than simply increasing carbohydrate intake. 3
Comprehensive Prevention Strategy
While salt avoidance is the correct answer to this question, optimal gastric cancer prevention requires a multifaceted dietary approach:
- Consume at least five servings of fruits and vegetables daily to provide dietary antioxidants (vitamin C, carotene, vitamin E) that offer significant protection. 2, 1
- Maintain a healthy weight, particularly to reduce abdominal obesity linked to gastric cardia cancers. 1
- Reduce consumption of processed foods, processed meats, and high-fat foods. 3
- Consider H. pylori testing and eradication in high-risk populations, as this is the most promising strategy to reduce gastric cancer incidence. 2
Clinical Implications
Year-round consumption of fresh foods and improved food preservation methods (refrigeration) have contributed to declining gastric cancer rates by reducing both salt exposure and H. pylori prevalence. 1 This underscores that dietary modification, particularly salt reduction, remains essential even in the era of H. pylori eradication programs, since mucosal changes from longstanding infection may not be fully reversible. 1
The frequency of consumption of highly salted foods such as salted fish roe and salted fish preserves is strongly associated with gastric cancer risk in both sexes. 5 Therefore, practical counseling should focus on identifying and eliminating these specific high-salt foods from the diet.