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Dietary salt intake linked to gastric cancer risk

1 commentBy Nathan Gray , 06-Feb-2012
Last updated on 06-Feb-2012 at 15:36 GMT

A new study investigating a link between high salt intake and risk of gastric cancers could add to increasing pressure for industry-wide sodium reduction, researchers have said.

The study – a meta-analysis of previous research published in Clinical Nutrition – investigated the relationship between habitual dietary salt intake and the risk of gastric cancer using data from nearly 270000 people. Using data from seven previous studies, the researchers reported to find “a graded positive association between salt consumption and incidence of gastric cancer.”

“Our pooled estimates indicate that habitual ‘high’ and ‘moderately high’ salt intake are associated with 68% and 41% greater risk of gastric cancer, respectively, compared with ‘low’ salt consumption,” said the research team, led by Professor Pasquale Strazzullo, from the University of Naples Federico II.

Speaking with FoodNavigator, Professor Graham MacGregor of the Wolfson Institute of Preventive Medicine, UK, and Chairman of Consensus Action on Salt and Health (CASH) said that whilst the findings of the study are not new, what it does do is confirm “in a very well done study” that previous findings are correct.

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Professor MacGregor explains the mechanisms and implications of the new meta-analysis.

“My own view is that it’s getting to the stage where we can say that it is almost certainly causative,” said MacGregor, who added that the meta-analysis offered further evidence for the mechanisms behind salt’s effect on gastric cancer.

Salt – some but not too much

Sodium is of course a vital nutrient and is necessary for the body to function, but the average daily salt consumption in the western world, between 10 and 12 grams, vastly exceeds maximum recommendations from WHO/FAO of 5 grams per day to control blood pressure levels and reduce hypertension prevalence and related health risks in populations.

In countries like the UK, Ireland, the USA, and other industrialized countries, over 80% of salt intake comes from processed food, and people therefore do not realize they are consuming it.

Previous research has suggested that increased consumption of salted foods could increase the risk of certain cancers – including gastric cancer.

“In general, the detection of statistical associations in prospective studies provides stronger support to the possibility of a cause–effect relationship; however, in the case of excess salt intake and risk of gastric cancer the cohort studies available did not show consistent results,” explained Strazzullo and his team.

“For this reason, we carried out a systematic review and meta-analysis of these studies to evaluate the association between habitual levels of dietary salt intake and risk of gastric cancer and to obtain an estimate of risk.”

Industry action

The process of reducing salt levels in foods is an ongoing process within the industry, with many now acknowledging that high sodium levels in some foods is a major issue for the industry.

Strazzullo and his colleagues explained that population reduction in salt intake –recognised as a global priority – through many avenues, including industry reformulation, has been suggested for the prevention of cardiovascular disease both in developed and developing countries.

“Although our results do not conclusively prove a causal relationship between excess salt intake and risk of gastric cancer, they do suggest the potential for further benefit by this policy in addition to its effects on cardiovascular morbidity and mortality,” they said.

MacGregor said that the latest findings “give another angle to salt reduction,” explaining that it adds into other evidence on cancer and cardiovascular disease to show that “reducing salt intakes globally needs to be a priority.”

“I think if you talk to most people in the food industry, then they would say that so long as it’s a level playing field, and everybody has to do it together, then they don’t mind doing it,” he said.

However, as simple as taking out some salt in foods might sound, the challenges associated with reducing levels in food are intricate and have major challenges in reformulation.

Speaking to FoodNavigator previously, Dr Paul Berryman, CEO of Leatherhead Food Research, explained that reducing salt in foods is “a complex issue.”

“Salt reduction sounds easy, but it isn't!” said Berryman, adding that the effects of salt reduction on food safety and shelf life are a particular worry because of salts action as a preservative.

Source: Clinical Nutrition
Published online ahead of print, doi: 10.1016/j.clnu.2012.01.003
“Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies”
Authors: L. D’Elia, G. Rossi, R. Ippolito, F.P. Cappuccio, P. Strazzullo

1 comment (Comments are now closed)

Salt Pylloried Without Evidence

The Netherlands and Norway results in this study were non-significant and the incidence of gastric cancer in these countries has long been more closely associated with nitrosamine formation than salt in the preserved foods. Furthermore, although described by the authors as a North American study, presumably in order to confer a more international character to the study, the US cohort consisted entirely of Hawaiian Japanese, confirming this study population is to be essentially Japanese. The high rates of gastric cancer have long been a great concern in Japan. There are a several hypotheses rationalizing the high risk of gastric cancer in Japan, one focusing on the asbestos content of the talc used to polish Japanese rice, and another stressing the virulence of certain East Asian strains of H. pylori. Other proposed risk factors including the known gastric carcinogen, N-methyl-N-nitro-N-nitrosoguanidine, a metabolite of one of the many taste enhancers common in Japanese foods have been suggested but, after much research, it appears that only the role of H. pylori infection itself is close to being settled in gastric cancer etiology. The potential for intragastric high-salt concentrations to damage mucosal barrier tissue and possibly increase the virulence of East Asian strains of H. pylori and salt consumption has thus far been demonstrated only in rodents. The prevalence of H. pylori IgG antibody among randomly selected Japanese men is in the vicinity or 80%. Considering all the available evidence, the goal of controlling gastric cancer in Japan and elsewhere in Asia would be far more quickly and practically served through the eradication of H. pylori infections rather than radical modifications of a culturally-adapted centuries-old diet.

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Posted by Morton Satin
06 February 2012 | 22h31

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