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These factors have been evaluated in a large case\u2013control study nested in the European Prospective Investigation into Cancer and Nutrition carried out in 9 countries, including the Mediterranean area. Participants, enrolled in 1992\u20131998, provided life\u2010style and dietary information and a blood sample (360,000; mean follow\u2010up: 6.1 years). For 233 GC cases diagnosed after enrolment and their 910 controls individually\u2010matched by center, gender, age and blood donation date <jats:italic>H. pylori<\/jats:italic> antibodies (antilysate and antiCagA) and plasma Pepsinogen A (PGA) were measured by ELISA methods. Severe chronic atrophic gastritis (SCAG) was defined as PGA circulating levels &lt;22 \u03bcg\/l. Overall, in a conditional logistic regression analysis adjusted for education, smoke, weight and consumption of total vegetables, fruit, red and preserved meat, <jats:italic>H. pylori<\/jats:italic> seropositivity was associated with GC risk. Subjects showing only antibodies anti\u2010<jats:italic>H. pylori<\/jats:italic> lysate, however, were not at increased risk, while those with antiCagA antibodies had a 3.4\u2010fold increased risk. Overall, the odds ratio associated with SCAG was 3.3 (95% CI 2.2\u20135.2). According to site, the risk of noncardia GC associated with CagA seropositivity showed a further increase (OR 6.5; 95% CI 3.3\u201312.6); on the other hand, a ten\u2010fold increased risk of cardia GC was associated with SCAG (OR 11.0; 95% CI 3.0\u201340.9). These results support the causal relationship between <jats:italic>H. pylori<\/jats:italic> CagA+ strains infection, and GC in these European populations even after taking into account dietary habits. This association was limited to distal GC, while serologically defined SCAG was strongly associated with cardia GC, thus suggesting a divergent risk pattern for these 2 sites. \u00a9 2006 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ijc.22435","type":"journal-article","created":{"date-parts":[[2006,11,27]],"date-time":"2006-11-27T22:31:24Z","timestamp":1164666684000},"page":"859-867","source":"Crossref","is-referenced-by-count":109,"title":["CagA+ <i>Helicobacter pylori<\/i> infection and gastric cancer risk in the EPIC\u2010EURGAST study"],"prefix":"10.1002","volume":"120","author":[{"given":"Domenico","family":"Palli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Masala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Del Giudice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Plebani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Basso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duccio","family":"Berti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattijs","family":"E. 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