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Research ArticleOriginal Article

Frequent low dose alcohol intake increases gastric cancer risk: the Health Examinees-Gem (HEXA-G) study

Hwi-Won Lee, Dan Huang, Woo-Kyoung Shin, Katherine de la Torre, Minkyo Song, Aesun Shin, Jong-Koo Lee and Daehee Kang
Cancer Biology & Medicine August 2022, 19 (8) 1224-1234; DOI: https://doi.org/10.20892/j.issn.2095-3941.2021.0642
Hwi-Won Lee
1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Dan Huang
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
3Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul 03080, Korea
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Woo-Kyoung Shin
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
3Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul 03080, Korea
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Katherine de la Torre
1Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Minkyo Song
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Aesun Shin
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Jong-Koo Lee
4Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Daehee Kang
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
3Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul 03080, Korea
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  • For correspondence: [email protected]
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    Figure 1

    Flow chart of the study population. HEXA, Health Examinees Study; GC, gastric cancer.

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    Table 1

    Baseline characteristics of the HEXA-G study population included in the alcohol consumption analysis (n = 128,218)†

    CharacteristicsMen (n = 42,152)P value*Women (n = 86,066)P value*
    Non-drinker (n = 8,968)Drinker (n = 33,184)Non-drinker (n = 58,825)Drinker (n = 27,241)
    n(%)n(%)n(%)n(%)
    Follow-up year (mean ± SD)8.7(2.0)8.7(2.0)0.6408.8(2.1)8.7(2.1)<0.001
    Age (mean ± SD)55.0(8.4)52.7(8.3)<0.00153.4(7.8)49.6(7.0)<0.001
    Family history of GC786(8.8)2,670(8.1)0.0685,053(8.6)2,239(8.2)0.192
    Education<0.001<0.001
    ≤Middle school2,044(22.8)6,681(20.1)22,566(38.4)8,681(31.9)
    High school diploma3,525(39.3)13,728(41.4)24,264(41.3)12,764(46.9)
    ≥College degree3,251(36.3)12,369(37.3)11,148(19.0)5,490(20.2)
    Married/cohabitation8,401(93.7)31,147(93.9)0.00551,203(87.0)23,337(85.7)<0.001
    Ever smokers‡4,887(54.5)25,566(77.0)<0.0011,146(2.0)1,882(6.9)<0.001
    Regular exercisers4,165(46.4)13,936(42.0)<0.00129,319(49.8)12,777(46.9)<0.001
    BMI (kg/m2, mean ± SD)23.7(4.5)23.7(1.1)<0.00123.7(2.5)23.7(4.1)<0.001
    Total energy intake (kcal, mean ± SD)563.7(115.3)1,871.0(559.7)<0.0011,700.36(568.0)1,736.64(605.2)<0.001

    HEXA-G, Health Examinees-Gem study; GC, gastric cancer; BMI, body mass index.

    *Student’s t-test for continuous variables; chi-square test for categorical variables.

    †Data for continuous variables are presented as mean ± standard deviation (SD); all other variables are presented as n (%).

    ‡Ever smokers is defined as lifetime smokers with ≥20 pack-years.

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      Table 2

      Associations between gastric cancer and alcohol consumption status, and the duration, frequency, and amount of ethanol consumed

      VariablesMen (n = 42,152)VariablesWomen (n = 86,066)
      nPerson-yearsGC(%)HR†95% CInPerson-yearsGC(%)HR†95% CI
      StatusStatus
      Non-drinker8,96877,92487(1.0)1.00RefNon-drinker58,825515,102283(0.5)1.00Ref
      Drinker33,184287,973375(1.1)1.311.031.66Drinker27,241235,840102(0.4)1.000.791.26
      DurationDuration
      Non-drinker8,96877,924871.0 1.00RefNon-drinker58,825515,1022830.5 1.00Ref
      ≤20 years7,71867,077590.8 1.390.991.97≤10 years3,44831,250150.4 1.120.661.89
      >20 years24,782214,2053111.3 1.321.031.68>10 years22,331189,090820.4 1.010.781.30
      P trend0.03P trend0.93
      FrequencyFrequency
      Non-drinker8,96877,92487(1.0)1.00RefNon-drinker58,825515,102283(0.5)1.00Ref
      ≤1 time/week9,85685,099113(1.2)1.321.001.75<1 time/week7,46763,97227(0.4)0.940.631.39
      2–3 times/week11,14896,494111(1.0)1.190.891.581 time/week11,746101,81747(0.4)1.090.801.50
      4 times/week7,05660,61978(1.1)1.350.991.85≥2 times/week6,81757,81122(0.3)0.940.601.45
      ≥5 times/week4,19436,15264(1.5)1.621.172.25P trend0.41
      P trend0.02
      Amount of ethanol‡Amount of ethanol‡
      Non-drinker8,96877,92487(1.0)1.00RefNon-drinker58,825515,102283(0.5)1.00Ref
      <10 g/week14,373123,873159(1.1)1.250.961.63<10 g/week7,99068,66132(0.4)1.000.691.44
      10–30 g/week10,31589,243118(1.1)1.371.031.8310–20 g/week8,97277,88336(0.4)1.090.771.56
      >30 g/week7,60265,62191(1.2)1.471.081.99>20 g/week9,08677,21528(0.3)0.920.621.37
      P trend0.03P trend0.49
      Continuous, per 1 SD1.001.001.00Continuous, per 1 SD0.870.651.17

      GC, gastric cancer; HR, hazard ratio; CI, confidence interval; SD, standard drink.

      †Adjusted for education, smoking status, marital status, family history of gastric cancer, exercise, BMI, and total energy intake.

      ‡Amount of ethanol refers to the amount of pure alcohol found in all alcohol beverages consumed by study participants, converted to grams per week.

        • View popup
        Table 3

        Association between alcohol consumption patterns and gastric cancer in men

        Consumption patternFrequencyAmount of ethanolnPerson-yearsGC(%)HR†95% CI
        Non-drinker8,96877,92487(1.0)0.780.610.99
        Infrequent-light<5 times/week<40 g ethanol/day25,884223,795282(1.1)1.00Ref
        Infrequent-heavy<5 times/week≥40 g ethanol/day1,0859,29312(1.1)1.140.642.03
        Frequent-light≥5 times/week<40 g ethanol/day1,95916,68935(1.8)1.461.022.07
        Frequent-heavy≥5 times/week≥40 g ethanol/day2,17318,96427(1.2)1.040.701.54

        GC, gastric cancer; HR, hazard ratio; CI, confidence interval.

        †Adjusted for education, smoking status, marital status, family history of gastric cancer, exercise, BMI, and total energy intake.

        Supplementary Materials

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        Cancer Biology & Medicine
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        15 Aug 2022
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        Frequent low dose alcohol intake increases gastric cancer risk: the Health Examinees-Gem (HEXA-G) study
        Hwi-Won Lee, Dan Huang, Woo-Kyoung Shin, Katherine de la Torre, Minkyo Song, Aesun Shin, Jong-Koo Lee, Daehee Kang
        Cancer Biology & Medicine Aug 2022, 19 (8) 1224-1234; DOI: 10.20892/j.issn.2095-3941.2021.0642

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        Frequent low dose alcohol intake increases gastric cancer risk: the Health Examinees-Gem (HEXA-G) study
        Hwi-Won Lee, Dan Huang, Woo-Kyoung Shin, Katherine de la Torre, Minkyo Song, Aesun Shin, Jong-Koo Lee, Daehee Kang
        Cancer Biology & Medicine Aug 2022, 19 (8) 1224-1234; DOI: 10.20892/j.issn.2095-3941.2021.0642
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        Keywords

        • Gastric cancer
        • alcohol consumption
        • drinking behavior
        • prospective cohort
        • Health Examinees-Gem (HEXA-G) study

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