Grain and legume consumption and risk of gastric cancer: Findings from a case–control study

Gastric cancer (GC) is a leading cause of cancer-related mortality worldwide, with dietary factors significantly influencing GC risk. However, research on the dietary influences of GC in Middle Eastern populations, particularly in Jordan, remains limited. This study aimed to assess the association between the consumption of grains and legumes and GC risk in a Jordanian population, hypothesizing that refined grains may increase GC risk, while whole grains and legumes may offer protective effects. A case–control study was conducted involving 173 newly diagnosed GC cases and 314 cancer-free controls recruited from major hospitals in Jordan. Data were collected through interview-based questionnaires. Consumption of grains and legumes was assessed using a validated Arabic food frequency questionnaire tailored to Jordanian dietary habits. Statistical analyses were adjusted for key confounders to isolate the impact of dietary intake on GC risk. The findings indicate that a higher intake of refined grains, particularly white bread, is positively associated with an increased risk of GC, as shown by an odds ratio (OR) of 3.13 (confidence interval [CI]: 1.57 – 6.21, p = 0.001). In contrast, moderate rice consumption is linked to a reduced risk of GC (OR = 0.38, CI: 0.18 – 0.81). Legumes, including hummus (OR = 0.48, CI: 0.26 – 0.97) and cooked dried beans (OR = 0.40, CI: 0.20 – 0.81), were found to have protective associations with GC risk. However, the consumption of green peas was unexpectedly associated with an increased GC risk (OR = 2.19, CI: 1.24 – 3.88, p = 0.004), potentially due to preparation methods or consumption patterns. This study provides evidence linking specific grains and legumes to GC risk in Jordan. Refined grains appear to increase GC risk, while legumes may offer protective benefits. These findings underscore the importance of public health interventions that encourage increased consumption of legumes and discourage refined grain intake to mitigate GC risk in similar populations.
- Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today; 2024. Available from: https://gco.iarc.who. int/today [Last accessed 2024 Oct 30].
- Lauwers G, Kumarasinghe P. Gastric Cancer: Pathology and Molecular Pathogenesis. United States: UpToDate, Inc.; 2023.
- American Cancer Society. What is Stomach Cancer? Available from: https://www.cancer.org/cancer/types/ stomach-cancer/about/what-is-stomach-cancer.html# [Last accessed 2024 Oct 30].
- National Institute of Cancer. What is Stomach Cancer? Available from: https://www.cancer.gov/types/stomach/ causes-risk-factors [Last accessed 2024 Oct 30].
- Mukkamalla SKR, Recio-Boiles A, Babiker HM. Gastric Cancer. StatPearls-NCBI Bookshelf; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459142/ [Last accessed 2024 Oct 30]
- Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric Cancer: Epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci. 2020;21(11):4012. doi: 10.3390/ijms21114012
- Maddineni G, Xie JJ, Brahmbhatt B, Mutha P. Diet and carcinogenesis of gastric cancer. Curr Opin Gastroenterol. 2022;38(6):588-591. doi: 10.1097/MOG.0000000000000875
- Liu SJ, Huang PD, Xu JM, et al. Diet and gastric cancer risk: An umbrella review of systematic reviews and meta-analyses of prospective cohort studies. J Cancer Res Clin Oncol. 2022;148(8):1855-1868. doi: 10.1007/s00432-022-04005-1
- Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9(10):1063. doi: 10.3390/nu9101063
- Wang T, Zhan R, Lu J, et al. Grain consumption and risk of gastric cancer: A meta-analysis. Int J Food Sci Nutr. 2019;71(2):164-175. doi: 10.1080/09637486.2019.1631264
- Bai X, Li X, Ding S, Dai D. Adherence to the mediterranean diet and risk of gastric cancer: A systematic review and meta-analysis. Nutrients. 2023;15(17):3826. doi: 10.3390/nu15173826
- Oncina-Canovas A, Gonzalez-Palacios S, Notario- Barandiaran L, et al. Adherence to pro-vegetarian food patterns and risk of oesophagus, stomach, and pancreas cancers: A multi case-control study (The PANESOES Study). Nutrients. 2022;14(24):5288. doi: 10.3390/nu14245288
- Lissowska J, Gail MH, Pee D, et al. Diet and stomach cancer risk in Warsaw, Poland. Nutr Cancer. 2004;48(2):149-59. doi: 10.1207/s15327914nc4802_4
- Xu Y, Yang J, Du L, Li K, Zhou Y. Association of whole grain, refined grain, and cereal consumption with gastric cancer risk: A meta-analysis of observational studies. Food Sci Nutr. 2019;7(1):256-265. doi: 10.1002/fsn3.878
- Aune D, De Stefani E, Ronco A, et al. Legume intake and the risk of cancer: A multisite case-control study in Uruguay. Cancer Causes Control. 2009;20(9):1605-1615. doi: 10.1007/s10552-009-9406-z
- Guo F, Danielski R, Santhiravel S, Shahidi F. Unlocking the nutraceutical potential of legumes and their by-products: Paving the way for the circular economy in the agri-food industry. Antioxidants (Basel). 2024;13(6):636. doi: 10.3390/antiox13060636
- Lee R, Nieman D. Nutritional Assessment. 6th ed. New York: McGraw-Hill Companies, Inc.; 2013.
- Sallis JF, Haskell WL, Wood PD, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985;121(1):91-106. doi: 10.1093/oxfordjournals.aje.a113987
- Washburn RA, Jacobsen DJ, Sonko BJ, Hill JO, Donnelly JE. The validity of the Stanford Seven-Day Physical Activity Recall in young adults. Med Sci Sports Exerc. 2003;35(8):1374-1380. doi: 10.1249/01.MSS.0000079081.08476.EA
- Tayyem R, Abu-Mweis S, Bawadi H, Agraib L, Bani-Hani K. Validation of a food frequency questionnaire to assess macronutrient and micronutrient intake among Jordanians. J Acad Nutr Diet. 2014;114(7):1046-1052.
- Nomura AM, Hankin JH, Kolonel LN, Wilkens LR, Goodman MT, Stemmermann GN. Case-control study of diet and other risk factors for gastric cancer in Hawaii (United States). Cancer Causes Control. 2003;14(6):547-558. doi: 10.1023/a:1024887411846
- Toorang F, Sasanfar B, Hekmatdoost A, et al. Macronutrient’s intake and stomach cancer risk in Iran: A hospital-based case-control study. J Res Health Sci. 2021;21:e00507. doi: 10.34172/jrhs.2021.38
- De Stefani E, Correa P, Boffetta P, Deneo-Pellegrini H, Ronco AL, Mendilaharsu M. Dietary patterns and risk of gastric cancer: A case-control study in Uruguay. Gastric Cancer. 2004;7(4):211-220. doi: 10.1007/s10120-004-0295-2
- Ji BT, Chow WH, Yang G, et al. Dietary habits and stomach cancer in Shanghai, China. Int J Cancer. 1998;76(5):659-664. doi: 10.1002/(sici)1097-0215(19980529)76:5<659::aid-ijc8>3.0.co;2-p
- Kim SY, Kwak JH, Eun CS, et al. Gastric cancer risk was associated with dietary factors irritating the stomach wall: A case-control study in Korea. Nutrients. 2022;14(11):2233. doi: 10.3390/nu14112233
- Denova-Gutierrez E, Hernandez-Ramirez RU, Lopez- Carrillo L. Dietary patterns and gastric cancer risk in Mexico. Nutr Cancer. 2014;66(3):369-376. doi: 10.1080/01635581.2014.884237
- Karagulle M, Fidan E, Kavgaci H, Ozdemir F. The effects of environmental and dietary factors on the development of gastric cancer. J BUON. 2014;19(4):1076-1082.
- Zhang XF, Wang XK, Tang YJ, et al. Association of whole grains intake and the risk of digestive tract cancer: A systematic review and meta-analysis. Nutr J. 2020;19(1):52. doi: 10.1186/s12937-020-00556-6
- Tayyem RF, Bawadi HA, Shehadah I, et al. Consumption of whole grains, refined cereals, and legumes and its association with colorectal cancer among Jordanians. Integr Cancer Ther. 2016;15(3):318-325. doi: 10.1177/1534735415620010
- Tayyem R, Al-Awwad N, Allehdan S, et al. Mediterranean dietary pattern is associated with lower odds of gastric cancer: A case-control study. Cancer Manag Res. 2022;14:2017-2029. doi: 10.2147/CMAR.S360468
- Rungruangmaitree R, Jiraungkoorskul W. Pea, Pisum sativum, and its anticancer activity. Pharmacogn Rev. 2017;11(21):39-42. doi: 10.4103/phrev.phrev_57_16
- Natale A, Fiori F, Parpinel M, et al. Dietary isoflavones intake and gastric cancer. Nutrients. 2024;16(16):2771. doi: 10.3390/nu16162771
- Vohra K, Dureja H, Garg V. An insight of pulses: From food to cancer treatment. J Pharmacogn Nat Prod. 2016;1:108
- Rao S, Chinkwo KA, Santhakumar AB, Blanchard CL. Inhibitory effects of pulse bioactive compounds on cancer development pathways. Diseases. 2018;6(3):72. doi: 10.3390/diseases6030072
- Gitlin-Domagalska A, Maciejewska A, Debowski D. Bowman- Birk inhibitors: Insights into family of multifunctional proteins and peptides with potential therapeutical applications. Pharmaceuticals (Basel). 2020;13(12):421. doi: 10.3390/ph13120421
- Shin WK, Lee HW, Huang D, et al. Soybean product consumption decreases risk of gastric cancer: Results from the Health Examinees Study. Eur J Nutr. 2023;62(4):1743-1753. doi: 10.1007/s00394-023-03115-x
- Faraji F, Shahidi SA, Shariatifar N, Ahmadi M. Evaluation of acrylamide concentration in commercial falafel available in Tehran City by different cooking methods: A health risk assessment study. Food Chem X. 2024;23:101750. doi: 10.1016/j.fochx.2024.101750