Sugar added to food can be the “villain” when it comes to the relationship between stomach cancer and unhealthy diet, while salt increases the risk of tumors for people with habits considered healthy. This is what research carried out in Brazil and published in the scientific journal shows BMC Medicine
The study considered an unhealthy eating pattern (PANS) to be one that includes a high consumption of processed meats, carbonated drinks rich in sugar and fast food . On the other hand, the healthy pattern (PAS) was characterized by a high intake of vegetables, fruits and a low level of sodium.
Scientists concluded that PANS is associated with an increased chance of gastric cancer, with sugars added to foods – introduced during processing to sweeten – contributing 7% to 21% in this relationship. Sodium consumption is the main mediating factor in the association of a healthy pattern and the risk of gastric adenocarcinoma. For saturated fatty acids and fiber, no mediating effects were found.
Using an innovative approach, the work analyzed data from a large sample of individuals from four capitals in different Brazilian regions. It involved 1,751 participants, including patients and controls, from São Paulo, Goiânia (GO), Fortaleza (CE) and Belém (PA), the latter being the one with the highest rates of the disease.
Gastric adenocarcinoma is a malignant tumor that develops in the innermost layer (mucosa) of the stomach, accounting for more than 90% of cases of this type. Stomach cancer is the sixth most common in Brazil, with an estimated 21,000 new records in the 2023-2025 period, according to the National Cancer Institute ( ). It also has a high risk of death – 75% of patients die within five years.
In the research (multicenter case-control), consumption patterns were identified through exploratory factor analysis (a statistical technique that identifies patterns and relationships underlying a set of variables), using an adapted food frequency questionnaire for each region of the country. , with 130 items. To break down the direct and indirect effects of these patterns on gastric cancer risk, the researchers performed a mediation analysis.
The conventional approach in the scientific literature dealing with the relationship between diet and cancer has focused on individual foods or nutrients, disregarding a broader perspective of dietary patterns, as adopted in this study.
“Each region and culture in Brazil has its own behavior. The eating habits of residents of Belém are not the same as those of Goiânia or São Paulo, but they can lead to the same disease. We decided to do case-control, that is, for each patient we look for another individual without disease in the same region. We also introduced a group that underwent endoscopy and did not have cancer. This was time-consuming, but we obtained an important result that contributes to elucidating the mechanisms involved in gastric cancer from an epidemiological perspective, with implications for public health,” oncologist Maria Paula Curado, head of the Epidemiology and Statistics Group in Cancer at the AC Camargo Cancer Center International Research Center.
Corresponding author and advisor to the first author of the article – oncology doctoral student and nutritionist Alex Richard Costa Silva –, Curado had support from FAPESP through the Thematic Project . Furthermore, the research had the international collaboration of researcher Gianfranco Alicandro, professor at the University of Milan (Italy).
“This study is part of my doctoral thesis and presents new perspectives on the relationship between diet and gastric adenocarcinoma. We emphasize that the role of added sugars is still little explored in the literature on food and gastric cancer, which brings new insights for future research”, adds Silva.
Relationship
Sodium is a risk factor that directly influences carcinogenesis. Excessive intake has harmful effects on the gastric mucosa, resulting in inflammation and interactions with colonization by Helicobacter pylori bacteria commonly found in the stomach, but which can cause gastritis, for example. Increased sodium intake can induce atrophic gastritis and metaplasia, complications resulting from chronic irritation of the gastric mucosa, leading to cancer.
A recent national dietary survey estimated that around 60% of the Brazilian adult population exceeds recommended sodium limits mainly through the consumption of white bread, toast, beans, rice and beef. Products labeled as “whole grain,” including breakfast cereals, breads and crackers, can also be high in sodium.
“The population lacks information about food. It's not terrorism, but rather popularizing the topic, explaining more about diets, teaching health workers, talking about it at service stations. It is necessary to create a philosophy of educating, informing and respecting the culture of each region. There is no point in telling someone who eats barbecue every day that they will no longer be able to eat it because they will die of cancer. It's not like that. You need to inform about the risks. What we want to do is prevention, early diagnosis and teaching healthy eating in a practical way and adapted to reality”, adds Curado, who since 2020 has been recognized in list of the “2% best scientists in the world” carried out by Stanford University/Elsevier.
In the study, the researchers highlight that Brazil implemented new food labeling legislation in 2022 to improve the understanding of nutritional information with the aim of helping consumers make informed choices.
According to labeling rules, it is mandatory to display the magnifying glass symbol indicating one or more nutrients when products contain, for example, 600 milligrams (mg) or more of sodium per 100 grams of solid food or 15 grams or more more added sugar per 100 grams.
The World Health Organization (WHO) recommends that sodium intake be less than 2 grams per day, the equivalent of 5 small level spoons (coffee) of salt. You Brazilians consume almost double the daily sodium recommendation
Regarding added sugar, the maximum consumption should be equivalent to 10% of daily calories. This means that, in a 2,000-calorie diet, for example, this percentage represents 50 grams of sugar per day or up to ten teaspoons. A 350 ml package of soda has, on average, 38 grams of added sugar.
The scientists suggest in the research the implementation of additional initiatives and strategies for healthier food options, aiming to reduce the intake of sodium and added sugars to prevent gastric cancer.
This content was originally published in Added sugar and salt increase risk of stomach cancer, says study on the CNN Brasil website.
Source: CNN Brasil