Challenging Epidemiological Strategy for Paradoxical Evidence on the Risk of Gastric Cancer from Helicobacter pylori Infection

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Abstract
The incidence of gastric cancer in the northeast Asian countries Japan, Korea and China is the highest in the world. The age-adjusted incidence rates (AAIRs) are 10 times higher than those in non-Hispanic Whites and four times higher than those in Japanese immigrants in Los Angeles, USA (1). The overall incidence rates of gastric cancer in Japan have been decreasing according to the changing pattern of Japanese dietary habit after World War II (2). A large number of epidemiological studies during the last several decades investigated dietary factors in relation to gastric cancer risk in the world and revealed dominant dietary and beverage factors: high intake of salted foods; low consumption of fresh vegetables and fruit and habitual cigarette smoking. The worldwide epidemic pattern of gastric cancer is closely associated with the characteristic lifestyle pattern in each country and ethnic group. Japanese immigrants to the USA were influenced by the American social and natural environment and changed their way of life, especially their dietary habits, generation by generation.

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