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However, studies investigating this association for gastric cancer, especially considering <jats:italic>Helicobacter pylori<\/jats:italic> (<jats:italic>H. pylori<\/jats:italic>) and atrophic gastritis (AG), are limited. We investigated gastric cancer risk associated with fish, shellfish, and n-3 polyunsaturated fatty acids (n-3 PUFAs)\u00a0consumption among Japanese adults.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>90,504 subjects enrolled in the Japan Public Health Center-based Prospective Study\u00a0(JPHC Study) were followed until December 2013. Dietary intake data were collected using a food frequency questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) were\u00a0calculated for gastric cancer risk associated with fish and shellfish\u00a0consumption and marine n-3 PUFAs (sum of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA)) using Cox proportional hazards models. Among those with avaliable data, we conducted a subgroup analysis taking\u00a0<jats:italic>H. pylori<\/jats:italic> infection\u00a0and AG\u00a0status\u00a0\u00a0into consideration.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 2,701 gastric cancer cases during an average of 15\u00a0years of follow-up. We observed an increased gastric cancer risk for salted fish consumption for men [HR for fifth quintile versus first quintile 1.43 (95% CI 1.18\u20131.75)] and for women [HR 1.33 (95% CI 1.00\u20131.77)]. We observed a weak risk reduction trend for women as the intake of\u00a0marine n-3 PUFAs increased (<jats:italic>p-<\/jats:italic>trend:0.07). When we included <jats:italic>H. pylori<\/jats:italic> infection and atrophic gastritis status in the analysis, the associations diminished.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our results suggest that salted fish increases gastric cancer risk for men and women, while marine n-3 PUFAs marginally decreases this risk among women in Japan.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00394-024-03343-9","type":"journal-article","created":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T08:01:45Z","timestamp":1714809705000},"page":"1529-1544","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between fish and shellfish consumption, n-3\u00a0polyunsaturated fatty acids, and gastric cancer risk: the Japan Public Health Center-based Prospective Study"],"prefix":"10.1007","volume":"63","author":[{"given":"Mayo","family":"Hirabayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calistus","family":"Wilunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utako","family":"Murai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiki","family":"Yamaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoki","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1276-2398","authenticated-orcid":false,"given":"Manami","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichiro","family":"Tsugane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norie","family":"Sawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the JPHC Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,4]]},"reference":[{"issue":"3","key":"3343_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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