{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:42:19Z","timestamp":1789558939975,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Instituto de Salud Carlos III-FEDER","award":["PI08\/1770, PI08\/0533, PI08\/1359, PS09\/00773-Cantabria, PS09\/01286-Le\u00f3n, PS09\/01903-Valencia, PS09\/02078-Huelva, PS09\/01662-Granada, PI11\/01403, PI11\/01889-FEDER, PI11\/00226, PI11\/01810, PI11\/02213, PI12\/00488, PI12\/00265, PI12\/01270, PI12\/00715, PI12\/0015"],"award-info":[{"award-number":["PI08\/1770, PI08\/0533, PI08\/1359, PS09\/00773-Cantabria, PS09\/01286-Le\u00f3n, PS09\/01903-Valencia, PS09\/02078-Huelva, PS09\/01662-Granada, PI11\/01403, PI11\/01889-FEDER, PI11\/00226, PI11\/01810, PI11\/02213, PI12\/00488, PI12\/00265, PI12\/01270, PI12\/00715, PI12\/0015"]}]},{"DOI":"10.13039\/501100019270","name":"Fundaci\u00f3n Marqu\u00e9s de Valdecilla","doi-asserted-by":"publisher","award":["API 10\/09"],"award-info":[{"award-number":["API 10\/09"]}],"id":[{"id":"10.13039\/501100019270","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ICGC International Cancer Genome Consortium CLL","award":["RD12\/0036\/0036"],"award-info":[{"award-number":["RD12\/0036\/0036"]}]},{"DOI":"10.13039\/501100014180","name":"Junta de Castilla y Le\u00f3n","doi-asserted-by":"publisher","award":["LE22A10-2"],"award-info":[{"award-number":["LE22A10-2"]}],"id":[{"id":"10.13039\/501100014180","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Consejer\u00eda de Salud of the Junta de Andaluc\u00eda","award":["PI-0571-2009, PI-0306-2011, salud201200057018tra"],"award-info":[{"award-number":["PI-0571-2009, PI-0306-2011, salud201200057018tra"]}]},{"name":"Conselleria de Sanitat of the Generalitat Valenciana","award":["AP_061\/10"],"award-info":[{"award-number":["AP_061\/10"]}]},{"name":"Recercaixa","award":["2010ACUP 00310"],"award-info":[{"award-number":["2010ACUP 00310"]}]},{"name":"European Commission grants","award":["FOOD-CT-2006-036224-HIWATE"],"award-info":[{"award-number":["FOOD-CT-2006-036224-HIWATE"]}]},{"name":"Spanish Association Against Cancer","award":["GCTRA18022MORE"],"award-info":[{"award-number":["GCTRA18022MORE"]}]},{"name":"Catalan Government- Agency for Management of University and Research Grants","award":["2017SGR723 and 2014SGR850"],"award-info":[{"award-number":["2017SGR723 and 2014SGR850"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The aim was to assess the effect of adherence to the Mediterranean Diet, measured with five different indexes, on the risk of gastric cancer. Data come from the multicase-control study MCC\u2014Spain, which included 354 gastric cancer cases and 3040 controls with data on diet. We used five indexes to evaluate adherence to the Mediterranean diet and assess the association between each pattern with the risk of gastric cancer, using multivariate logistic regression. The analyses were performed for the whole set of gastric cancer cases, by anatomical location (cardia and non-cardia) and by histological type (intestinal and diffuse). According to the used index, a high adherence protects one from gastric cancer (between 48% (aOR = 0.52; CI 95% = 0.28\u20130.94) and 75% (aOR = 0.25; CI 95% = 0.12\u20130.52)), from non-cardia (between 48% (aOR = 0.52; CI 95% = 0.36\u20130.75) and 65% (aOR = 0.35; CI 95% = 0.23\u20130.52)), and from the intestinal type (between 41% (aOR = 0.59; CI 95% = 0.36\u20130.95) and 72% (aOR = 0.28; CI 95% = 0.16\u20130.50)), but not from the diffuse type. In conclusion, high adherence to a Mediterranean diet pattern is a protective factor for the risk of gastric cancer, with greater adherence leading to greater protection.<\/jats:p>","DOI":"10.3390\/cancers13215281","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T14:37:48Z","timestamp":1634827068000},"page":"5281","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Relationship between the Risk of Gastric Cancer and Adherence to the Mediterranean Diet According to Different Estimators. MCC\u2014Spain Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-8314","authenticated-orcid":false,"given":"Laura","family":"\u00c1lvarez-\u00c1lvarez","sequence":"first","affiliation":[{"name":"Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of Le\u00f3n, 24071 Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3118-3570","authenticated-orcid":false,"given":"Facundo","family":"Vitelli-Storelli","sequence":"additional","affiliation":[{"name":"Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of Le\u00f3n, 24071 Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0916-4215","authenticated-orcid":false,"given":"Mar\u00eda","family":"Rub\u00edn-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of Le\u00f3n, 24071 Le\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Aragon\u00e9s","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Ardanaz","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Navarra Institute for Health Research (IdiSNA) Navarra Public Health Institute, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4468-1816","authenticated-orcid":false,"given":"Gemma","family":"Casta\u00f1o-Vinyals","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Ob\u00f3n-Santacana","sequence":"additional","affiliation":[{"name":"Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L\u2019Hospitalet Del Llobregat, 08908 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trinidad","family":"Dierssen-Sotos","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Universidad de Cantabria\u2014IDIVAL, 39005 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Salas-Trejo","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Valencian Breast Cancer Screening Program, General Directorate of Public Health, 46020 Val\u00e8ncia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5150-1209","authenticated-orcid":false,"given":"Adonina","family":"Tard\u00f3n","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Department of Medicine, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7917-6145","authenticated-orcid":false,"given":"Jos\u00e9 Juan Jim\u00e9nez","family":"Mole\u00f3n","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), Hospitales Universitarios de Granada, Universidad de Granada, 18012 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Alguacil","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, Campus Universitario de El Carmen, 21004 Huelva, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Dolores","family":"Chirlaque","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"P\u00e9rez-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Poll\u00e1n","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain"},{"name":"Cancer and Environmental Epidemiology Unit, Department of 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1002\/ijc.31937","article-title":"Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods","volume":"144","author":"Ferlay","year":"2018","journal-title":"Int. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1158\/1055-9965.EPI-13-1057","article-title":"Gastric cancer: Descriptive epidemiology, risk factors, screening, and prevention","volume":"23","author":"Karimi","year":"2014","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.gtc.2013.01.003","article-title":"Gastric Cancer. Epidemiology and Risk Factors","volume":"42","author":"Forman","year":"2013","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5114\/pg.2018.80001","article-title":"Epidemiology of gastric cancer: Global trends, risk factors and prevention","volume":"14","author":"Rawla","year":"2019","journal-title":"Gastroenterol. Rev."},{"key":"ref_5","unstructured":"World Cancer Research Fund International\/American Institute for Cancer Research (2021, May 01). Continuous Update Project Report: Diet, Nutrition, Physical Activity and Stomach Cancer. Available online: wcrf.org\/stomach-cancer-2016."},{"key":"ref_6","first-page":"118","article-title":"C\u00e1ncer g\u00e1strico","volume":"12","year":"2016","journal-title":"Rev. M\u00e9d. Cl\u00edn. Las Condes"},{"key":"ref_7","unstructured":"Ram\u00edrez Sabio, J.B. (2021, May 01). Efectos de la dieta Mediterr\u00e1nea y de sus Principales Componentes en la Morbi-mortalidad por c\u00e1ncer y su modulaci\u00f3n gen\u00e9tica en el Estudio PREDIMED. University of Valencia. Available online: https:\/\/roderic.uv.es\/handle\/10550\/60755."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1038\/s41568-019-0227-4","article-title":"Dietary Patterns and Cancer Risk","volume":"20","author":"Steck","year":"2020","journal-title":"Nat. Rev. Cancer Nat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1093\/nutrit\/nux012","article-title":"Possible Role of Diet in Cancer: Systematic Review and Multiple Meta-Analyses of Dietary Patterns, lifestyle Factors, and Cancer Risk","volume":"75","author":"Grosso","year":"2017","journal-title":"Nutr. Rev."},{"key":"ref_10","first-page":"1044","article-title":"Current evidence on health benefits of the Mediterranean diet","volume":"144","author":"Dussaillant","year":"2016","journal-title":"Rev. Med. Chil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s10120-019-00927-x","article-title":"Mediterranean diet adherence and risk of esophageal and gastric cancer sub-types in the Netherlands Cohort Study","volume":"22","author":"Schulpen","year":"2019","journal-title":"Gastric Cancer"},{"key":"ref_12","first-page":"372","article-title":"High adherence to the Western, Prudent, and Mediterranean dietary patterns and risk of gastric adenocarcinoma: MCC-Spain study","volume":"21","author":"Researchers","year":"2017","journal-title":"Gastric Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schwingshackl, L., Schwedhelm, C., Galbete, C., and Hoffmann, G. (2017). Adherence to Mediterranean Diet and Risk of Cancer: An Up-dated Systematic Review and Meta-Analysis. Nutrients, 9.","DOI":"10.3390\/nu9101063"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1002\/ijc.28620","article-title":"Adherence to the Mediterranean diet and gastric cancer risk in Italy","volume":"134","author":"Praud","year":"2013","journal-title":"Int. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1038\/sj.bjc.6604418","article-title":"Conformity to traditional Mediterranean diet and cancer incidence: The Greek EPIC cohort","volume":"99","author":"Benetou","year":"2008","journal-title":"Br. J. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3945\/ajcn.2009.28209","article-title":"Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study","volume":"91","author":"Buckland","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1056\/NEJMoa025039","article-title":"Adherence to a Mediterranean diet and survival in a Greek population","volume":"348","author":"Trichopoulou","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.1017\/S1368980011002606","article-title":"Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet","volume":"14","author":"Puig","year":"2011","journal-title":"Public Health Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Olmedo-Requena, R., Gonz\u00e1lez-Donquiles, C., D\u00e1vila-Batista, V., Romaguera, D., Castell\u00f3, A., Molina de la Torre, A., Ami-ano, P., Dierssen-Sotos, T., Guevara, M., and Fern\u00e1ndez-Tard\u00f3n, G. (2019). Agreement among Mediterranean Diet Pattern Adherence Indexes: MCC-Spain Study. Nutrients, 11.","DOI":"10.3390\/nu11030488"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1079\/PHN2005936","article-title":"The Use of Indexes Evaluating the Adherence to the Mediterranean Diet in Epidemiological Studies: A Review","volume":"9","author":"Bach","year":"2006","journal-title":"Public Health Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.gaceta.2014.12.003","article-title":"Population-based multicase-control study in common tumors in Spain (MCC-Spain): Rationale and study design","volume":"29","author":"Aragones","year":"2015","journal-title":"Gac. Sanit."},{"key":"ref_22","unstructured":"(2021, May 03). FFQ MCC-Spain. Available online: http:\/\/www.mccspain.org\/wp-content\/uploads\/2016\/04\/03_Cuestionario-alimentario_09Nov09.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.ejca.2007.05.007","article-title":"Food, nutrient and heterocyclic amine intake and the risk of bladder cancer","volume":"43","author":"Kogevinas","year":"2007","journal-title":"Eur. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1093\/aje\/kwp282","article-title":"Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study","volume":"170","author":"Buckland","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/ajcn\/82.1.163","article-title":"Diet-Quality Scores and Plasma Concentrations of Markers of Inflammation and Endothelial Dysfunction","volume":"82","author":"Fung","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ypmed.2006.12.009","article-title":"Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore","volume":"44","author":"Panagiotakos","year":"2007","journal-title":"Prev. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1080\/09637486.2017.1287884","article-title":"Validation of a literature-based adherence score to Mediterranean diet: The MEDI-LITE score","volume":"68","author":"Sofi","year":"2017","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/CEJ.0000000000000371","article-title":"Adherence to Mediterranean diet and risk of gastric cancer: Results of a case\u2013control study in Italy","volume":"26","author":"Stojanovic","year":"2017","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1017\/S0007114519002976","article-title":"Index-based dietary patterns in relation to gastric cancer risk: A systematic review and meta-analysis","volume":"123","author":"Du","year":"2019","journal-title":"Br. J. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.cgh.2013.03.023","article-title":"Index-based Dietary Patterns and Risk of Esophageal and Gastric Cancer in a Large Cohort Study","volume":"11","author":"Li","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1093\/ajcn\/nqx070","article-title":"Effect of the Mediterranean Diet on Cognition and Brain Morphology and Function: A Systematic Review of Randomized Controlled Trials","volume":"107","author":"Duffy","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1017\/S1368980013003169","article-title":"Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score","volume":"17","author":"Sofi","year":"2013","journal-title":"Public Health Nutr."},{"key":"ref_33","first-page":"1741","article-title":"Patr\u00f3n de dieta mediterr\u00e1neo y occidental en poblaci\u00f3n adulta de un \u00e1rea mediterr\u00e1nea; un an\u00e1lisis cl\u00faster","volume":"28","author":"Quiles","year":"2013","journal-title":"Nutr. Hosp."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/21\/5281\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:20:05Z","timestamp":1760167205000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/21\/5281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":33,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["cancers13215281"],"URL":"https:\/\/doi.org\/10.3390\/cancers13215281","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]}}}