Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2009; 15(18): 2204-2213
Published online May 14, 2009. doi: 10.3748/wjg.15.2204
Review of salt consumption and stomach cancer risk: Epidemiological and biological evidence
Xiao-Qin Wang, Paul D Terry, Hong Yan
Xiao-Qin Wang, Hong Yan, Department of Epidemiology, School of Medicine, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Paul D Terry, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, United States
Author contributions: Wang XQ collected the data and wrote the initial draft of the manuscript; Yan H did overall scientific direction and revision; Terry PD assisted in the revision of this manuscript.
Correspondence to: Xiao-Qin Wang, MD, Department of Epidemiology, School of Medicine, Xi’an Jiaotong University, 76# West Yantan Road, Xi’an 710061, Shaanxi Province, China.
Telephone: +86-29-82655015
Fax: +86-29-82655015
Received: January 5, 2009
Revised: March 23, 2009
Accepted: March 30, 2009
Published online: May 14, 2009

Stomach cancer is still the fourth most common cancer; thus, it remains an important public health burden worldwide, especially in developing countries. The remarkable geographic variations in the rates of stomach cancer indicate that dietary factors, including a range of food groups to which salt and/or nitrates have been added, may affect stomach cancer risk. In this paper, we review the results from ecologic, case-control and cohort studies on the relationship between salt or salted foods and stomach cancer risk. The majority of ecological studies indicated that the average salt intake in each population was closely correlated with gastric cancer mortality. Most case-control studies showed similar results, indicating a moderate to high increase in risk for the highest level of salt or salted food consumption. The overall results from cohort studies are not totally consistent, but are suggestive of a moderate direct association. Since salt intake has been correlated with Helicobacter pylori (H pylori) infection, it is possible that these two factors may synergize to promote the development of stomach cancer. Additionally, salt may also cause stomach cancer through directly damaging gastric mucus, improving temporary epithelial proliferation and the incidence of endogenous mutations, and inducing hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer. Based on the considerable evidence from ecological, case-control and cohort studies worldwide and the mechanistic plausibility, limitation on salt and salted food consumption is a practical strategy for preventing gastric cancer.

Keywords: Disease prevention, Helicobacter pylori infection, Salt consumption, Stomach cancer