Dietary intake of heme iron and risk of gastric cancer in the European prospective investigation into cancer and nutrition study

Background: Even though recent studies suggest that a high intake of heme iron is associated with several types of cancer, epidemiological studies in relation to gastric cancer (GC) are lacking. Our previous results show a positive association between red and processed meat and non cardia gastric cancer, especially in Helicobacter pylori infected subjects. Aim: To investigate the association between heme iron intake and GC risk in the European Prospective Investigation into Cancer and Nutrition (EURGAST-EPIC). Material and Methods: dietary intake was assessed by validated centre-specific questionnaires. Heme iron was calculated as a type-specific percentage of the total iron content in meat intake, derived from the literature. Antibodies of Hp infection and vitamin C levels were measured in a sub-sample of cases and matched controls included in a nested case-control study within the cohort. Results: The study included 481,419 individuals and 444 incident cases of GC that occurred during an average of 8.7 years of follow-up. We observed a statistically significant association between heme iron intake and GC risk (HR 1.13 95% CI: 1.01-1.26 for a doubling of intake) adjusted by sex, age, BMI, education level, tobacco smoking and energy intake. The positive association between heme iron and the risk of GC was statistically significant in subjects with plasma vitamin C