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      Long-Term Coffee Consumption and Risk of Gastric Cancer : A PRISMA-Compliant Dose–Response Meta-Analysis of Prospective Cohort Studies

      , MD, , MM, , MM, , MM, , MM, , MD

      Medicine

      Wolters Kluwer Health

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          Abstract

          Association between coffee consumption and gastric cancer risk remains controversial. Hence, we performed a meta-analysis to investigate and quantify the potential dose–response association between long-term coffee consumption and risk of gastric cancer.

          Pertinent studies were identified by searching PubMed and Embase from January 1996 through February 10, 2015 and by reviewing the reference lists of retrieved publications. Prospective cohort studies in which authors reported effect sizes and corresponding 95% confidence intervals (CIs) of gastric cancer for 3 or more categories of coffee consumption were eligible. Results from eligible studies were aggregated using a random effect model. All analyses were carried out using the STATA 12.0 software.

          Nine studies involving 15 independent prospective cohorts were finally included. A total of 2019 incident cases of gastric cancer were ascertained among 1,289,314 participants with mean follow-up periods ranging from 8 to 18 years. No nonlinear relationship of coffee consumption with gastric cancer risk was indentified ( P for nonlinearity = 0.53; P for heterogeneity = 0.004). The linear regression model showed that the combined relative risk (RR) of every 3 cups/day increment of total coffee consumption was 1.07 (95% CI = 0.95–1.21). Compared with the lowest category of coffee consumption, the RR of gastric cancer was 1.18 (95% CI = 0.90–1.55) for the highest (median 6.5 cups/day) category, 1.06 (95% CI = 0.85–1.32) for the second highest category (median 3.5 cups/day), and 0.97 (95% CI = 0.79–1.20) for the third highest category (median 1.5 cups/day). Subgroup analysis showed an elevated risk in the US population (RR = 1.36, 95% CI = 1.06–1.75) and no adjustment for smoking (RR = 1.67, 95% CI = 1.08–2.59) for 6.5 cups/day.

          Current evidence indicated there was no nonlinear association between coffee consumption and gastric cancer risk. However, high coffee consumption (more than 6.5 cups/day) might increase the risk of gastric cancer in the US population. More high quality studies were warranted to further investigate the association.

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          Most cited references 47

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          Measuring inconsistency in meta-analyses.

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            Bias in meta-analysis detected by a simple, graphical test.

            Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews. Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution.
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              Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

              David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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                Author and article information

                Affiliations
                From the Department of Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan (S-BZ, MZ, X-TZ); Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan (HW, X-TZ); Department of Digestive Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan (X-LD); and Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, TX, USA (X-FS).
                Author notes
                Correspondence: Xian-Tao Zeng, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan 430071, P.R. China (e-mail: zengxiantao1128@ 123456163.com ).
                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2015
                25 September 2015
                : 94
                : 38
                01640
                10.1097/MD.0000000000001640
                4635778
                26402838
                Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

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                Research Article
                Systematic Review and Meta-Analysis
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