Dietary Polyphenol Intake and Gastric Cancer: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: Phenolic compounds are the most abundant antioxidants in the human diet. There are about eight thousand types of phenols, but the main classes are flavonoids, phenolic acids, stilbenes, lignans, and other polyphenols. These compounds have anticarcinogenic properties and may exert a protective effect against several cancers, including Gastric Cancer (GC). However, previous studies investigating GC have focused on flavonoids and the results are controversial. Our systematic review with meta-analysis is the first to report the association between total polyphenol intake, as well as the consumption of more than two classes of polyphenols concomitantly, and GC risk. Polyphenol consumption decreased the risk of GC in both sexes, but to a greater extent in females. The risk reduction was greater in studies carried out in Europe and Asia, therefore further studies in the Latin American population are warranted. Considering the high incidence rates of GC worldwide and the fact modifiable risk factors, such as diet, are amenable to intervention, the findings from this systematic review and meta-analysis can help strengthen strategies to encourage the consumption of foods rich in polyphenols and reduce the incidence of GC. ABSTRACT: Background: Phenolic compound consumption may have a protective effect against gastric cancer (GC). Most GC studies focus on the flavonoids class, but results are conflicting and knowledge gaps remain for other classes and total polyphenol intake. This study aimed to assess the association between polyphenol intake (total, flavonoids, and other classes) and GC. Methods: In this systematic review and meta-analysis, the PubMed, Embase, Scopus, LILACS, Web of Science, and OpenGrey databases were searched for studies published up to 20 March 2022. Case–control and cohort studies analyzing the association between polyphenol intake and GC were included. For the meta-analysis, pooled summary estimates were calculated using a random-effects model, and the estimates extracted adjusted for most variables. Subgroup analyses were performed for subclass (e.g., flavonoids and other classes), sex, geographical area, study design, anatomical subtype, histological subtype, family history of GC and fruit and/or vegetable intake. The study was registered with PROSPERO (#CRD42022306014). Findings: The search identified 2752 records, of which 19 studies published during the period 1999–2021 including a total of 1,197,857 subjects were eligible. Polyphenol consumption reduced GC risk by 29% (RR = 0.71; 95% CI: 0.62–0.81; I(2) = 60.5%); while flavonoid intake decreased GC risk by 28% (RR = 0.72; 95% CI: 0.61–0.85; I(2) = 64.3%), similar to the reduction fort other classes (RR = 0.65; 95% CI: 0.54–0.79; I(2) = 72.0%). Protective effects against GC were observed in both sexes (male, RR = 0.79; 95% CI: 0.67–0.94, I(2) = 31.6%; female, RR = 0.65; 95% CI: 0.48–0.87, I(2) = 49.7%) and for intestinal subtype (RR = 0.65; 95% CI: 0.52–0.82, I(2) = 0.0%). By continent, polyphenol consumption reduced GC risk in both Europe (RR = 0.67; 95% CI: 0.57–0.79, I(2) = 44.2%) and Asia (RR = 0.67; 95% CI: 0.51–0.89, I(2) = 60.7%). Conclusions: Dietary polyphenol intake decreased GC risk. The reduction was greatest in females. Most previous studies were carried out in Europe and Asia. Further studies investigating polyphenol consumption and GC in Latin American populations are warranted.