{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:06:12Z","timestamp":1789430772549,"version":"build-2803163510"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background\/Objectives: Gastric mucosal lesions represent a significant health burden, with Helicobacter pylori infection being the primary cause of chronic gastritis worldwide. However, the role of modifiable lifestyle factors in modulating the severity of gastric lesions remains incompletely characterized, particularly in Eastern European populations. This study aimed to analyze the relationship between dietary behaviors, smoking, alcohol consumption, and the severity of endoscopic gastric lesions in Romanian patients. Methods: We conducted a cross-sectional study including 361 patients who underwent upper gastrointestinal endoscopy at T\u00e2rgu Mure\u0219 County Clinical Emergency Hospital between 2019 and 2025. Endoscopic lesion severity was classified on an ordinal scale (0 = normal; 1 = edema\/erythema; 2 = erosions; 3 = ulcer\/bleeding). Dietary intake was assessed using a validated food frequency questionnaire, with foods classified as pro-inflammatory or protective. Ordinal logistic regression models were used to examine associations between lifestyle factors and the severity of gastric lesions, adjusted for age, sex, and H. pylori status. Results: Among participants (median age 65 years, 46.5% male), 45.2% had clinically significant lesions (\u22652). H. pylori infection was present in 31.6% of participants. Current smoking (15.2% of participants) showed a trend toward increased severity of gastric lesions (fully adjusted OR 1.59, 95% CI 0.93\u20132.71, p = 0.092), though not statistically significant. Among current smokers, 52.7% had clinically significant lesions versus 43.8% among non\/former smokers. The smoking\u2013alcohol interaction was not statistically significant (interaction OR = 1.19, 95% CI: 0.34\u20134.17, p = 0.780). Dietary balance score showed no association with the severity of gastric lesions (OR = 1.061 per 10-unit increase, p = 0.355). NSAID use emerged as the strongest predictor (OR = 1.68, 95% CI 1.01\u20132.78, p = 0.044). The number of cumulative risk factors correlated significantly with clinically significant lesions (Spearman r = 0.107, p = 0.042), with prevalence increasing from 34.5% in patients with 0\u20131 factors to 83.3% with 6+ factors. Conclusions: Current smoking showed a trend toward increased severity of gastric lesions in this Romanian cohort, though not reaching statistical significance. NSAID use was the only significant independent predictor. The dose\u2013response relationship between cumulative risk factors and the severity of lesions emphasizes the importance of comprehensive risk assessment and multi-factorial interventions in gastric disease prevention. However, as a cross-sectional study, these associations cannot establish causality and should be confirmed in prospective cohorts.<\/jats:p>","DOI":"10.3390\/life15091474","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T12:33:32Z","timestamp":1758285212000},"page":"1474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors for Endoscopic Gastric Mucosal Lesions: Analysis of Lifestyle, Dietary, and Clinical Determinants in 361 Patients"],"prefix":"10.3390","volume":"15","author":[{"given":"Patrick-Laz\u0103r-Dominik","family":"Chiciudean","sequence":"first","affiliation":[{"name":"Oncology Department, Mure\u0219 County Clinical Hospital, 540140 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Filip","sequence":"additional","affiliation":[{"name":"Department of Clinical Science-Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Phamacy, Science, and Technology, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3059-9006","authenticated-orcid":false,"given":"Sabrina-Nicoleta","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Department of Clinical Science-Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Phamacy, Science, and Technology, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian-Ioan","family":"C\u00eempian","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Emergency County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Mocan","sequence":"additional","affiliation":[{"name":"Pathology Department, Emergency County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Pantea","sequence":"additional","affiliation":[{"name":"Department of Clinical Science-Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Phamacy, Science, and Technology, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2115-6576","authenticated-orcid":false,"given":"Anca Elena","family":"Negovan","sequence":"additional","affiliation":[{"name":"Department of Clinical Science-Internal Medicine, \u201cGeorge Emil Palade\u201d University of Medicine, Phamacy, Science, and Technology, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Marino, P., Mininni, M., Deiana, G., Marino, G., Divella, R., Bochicchio, I., Giuliano, A., Lapadula, S., Lettini, A.R., and Sanseverino, F. (2024). Healthy Lifestyle and Cancer Risk: Modifiable Risk Factors to Prevent Cancer. Nutrients, 16.","DOI":"10.3390\/nu16060800"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gutjnl-2015-309252","article-title":"Kyoto Global Consensus Report on Helicobacter pylori Gastritis","volume":"64","author":"Sugano","year":"2015","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S2468-1253(23)00070-5","article-title":"Global Prevalence of Helicobacter pylori Infection between 1980 and 2022: A Systematic Review and Meta-Analysis","volume":"8","author":"Li","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_4","first-page":"3488","article-title":"Prevalence of Helicobacter pylori Infection among Dyspeptic Patients in Northwestern Romania: A Decreasing Epidemiological Trend in the Last 30 Years","volume":"20","author":"Corojan","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Inoue, M. (2024). Epidemiology of Gastric Cancer\u2014Changing Trends and Global Disparities. Cancers, 16.","DOI":"10.3390\/cancers16172948"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Balendra, V., Amoroso, C., Galassi, B., Esposto, J., Bareggi, C., Luu, J., Scaramella, L., and Ghidini, M. (2023). High-Salt Diet Exacerbates H. pylori Infection and Increases Gastric Cancer Risks. J. Pers. Med., 13.","DOI":"10.3390\/jpm13091325"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wu, X., Chen, L., Cheng, J., Qian, J., Fang, Z., and Wu, J. (2022). Effect of Dietary Salt Intake on Risk of Gastric Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies. Nutrients, 14.","DOI":"10.3390\/nu14204260"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhu, H., Yang, X., Zhang, C., Zhu, C., Tao, G., Zhao, L., Tang, S., Shu, Z., Cai, J., and Dai, S. (2013). Red and Processed Meat Intake Is Associated with Higher Gastric Cancer Risk: A Meta-Analysis of Epidemiological Observational Studies. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0070955"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1093\/jnci\/djj301","article-title":"Processed Meat Consumption and Stomach Cancer Risk: A Meta-Analysis","volume":"98","author":"Larsson","year":"2006","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kim, S.R., Kim, K., Lee, S.A., Kwon, S.O., Lee, J.-K., Keum, N., and Park, S.M. (2019). Effect of Red, Processed, and White Meat Consumption on the Risk of Gastric Cancer: An Overall and Dose\u2013Response Meta-Analysis. Nutrients, 11.","DOI":"10.3390\/nu11040826"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"917","DOI":"10.7314\/APJCP.2016.17.3.917","article-title":"Helicobacter pylori Infection and Dietary Factors Act Synergistically to Promote Gastric Cancer","volume":"17","author":"Raei","year":"2016","journal-title":"Asian Pac. J. Cancer Prev. APJCP"},{"key":"ref_12","first-page":"67","article-title":"Flavonoids, Vitamin C and Adenocarcinoma of the Stomach","volume":"15","author":"Lagiou","year":"2004","journal-title":"Cancer Causes Control"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1186\/s12967-024-05176-w","article-title":"Adherence to the Mediterranean Diet and Its Association with Gastric Cancer: Health Benefits from a Planeterranean Perspective","volume":"22","author":"Zambrano","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmj.3.5875.313","article-title":"Effect of Cigarette Smoking on Competence of the Pylorus: Preliminary Study","volume":"3","author":"Read","year":"1973","journal-title":"Br. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e84051","DOI":"10.7554\/eLife.84051","article-title":"Smoking, Alcohol Consumption, and 24 Gastrointestinal Diseases: Mendelian Randomization Analysis","volume":"12","author":"Yuan","year":"2023","journal-title":"eLife"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1254\/jphs.94.348","article-title":"The Pharmacological Actions of Nicotine on the Gastrointestinal Tract","volume":"94","author":"Wu","year":"2004","journal-title":"J. Pharmacol. Sci."},{"key":"ref_17","first-page":"G237","article-title":"Effects of Ethanol on Gastric Epithelial Cell Phospholipid Dynamics and Cellular Function","volume":"252","author":"Bailey","year":"1987","journal-title":"Am. J. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1159\/000171159","article-title":"Effects of Ethanol on the Gastric Mucosa","volume":"5","author":"Guslandi","year":"1987","journal-title":"Dig. Dis. Basel Switz."},{"key":"ref_19","unstructured":"World Health Organization (2019). Romania: Alcohol Consumption Country Profile 2019, World Health Organization. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/country-profiles\/substances-abuse\/rou.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"766","DOI":"10.3892\/etm.2021.10198","article-title":"Helicobacter pylori Infection over Bile Reflux: No Influence on the Severity of Endoscopic or Premalignant Gastric Lesion Development","volume":"22","author":"Mocan","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chen, S., Yang, S., Wang, S., Li, H., Li, R., Li, H., Shi, Y., Yang, J., Bao, Y., and Du, S. (2024). Smoking Cessation and Mortality Risk Reduction in Older Adults with Long-Term Smoking History. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20270-w"},{"key":"ref_22","unstructured":"(2025, August 12). International Guide for Monitoring Alcohol Consumption and Related Harm. Available online: https:\/\/www.who.int\/publications\/i\/item\/international-guide-for-monitoring-alcohol-consumption-and-related-harm."},{"key":"ref_23","first-page":"117","article-title":"Validation of the romanian version of a self-administered food frequency questionnaire","volume":"26","author":"Roman","year":"2019","journal-title":"Romanian J. Diabetes Nutr. Metab. Dis."},{"key":"ref_24","first-page":"170","article-title":"Multivariate analysis of the association between consumption of fried food and gastric cancer and precancerous lesions","volume":"52","author":"Guo","year":"2018","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e025623","DOI":"10.1136\/bmjopen-2018-025623","article-title":"Salt Content of Sauces in the UK and China: Cross-Sectional Surveys","volume":"9","author":"Tan","year":"2019","journal-title":"BMJ Open"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Khan, J., Gul, P., Rashid, M.T., Li, Q., and Liu, K. (2024). Composition of Whole Grain Dietary Fiber and Phenolics and Their Impact on Markers of Inflammation. Nutrients, 16.","DOI":"10.3390\/nu16071047"},{"key":"ref_27","first-page":"101121","article-title":"Analysis of Black Rice and Some Other Cereal Grains for Protein, Sugar, Polyphenols, Antioxidant and Anti-Inflammatory Properties","volume":"16","author":"Khatun","year":"2024","journal-title":"J. Agric. Food Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Milesi, G., Rangan, A., and Grafenauer, S. (2022). Whole Grain Consumption and Inflammatory Markers: A Systematic Literature Review of Randomized Control Trials. Nutrients, 14.","DOI":"10.3390\/nu14020374"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2147\/CEG.S153231","article-title":"Endoscopic Comparison of Gastroduodenal Injury with Over-the-Counter Doses of New Fast-Dissolving Ibuprofen and Paracetamol Formulations: A Randomized, Placebo-Controlled, 4-Way Crossover Clinical Trial","volume":"11","author":"Lanza","year":"2018","journal-title":"Clin. Exp. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00535-023-01967-y","article-title":"Smoking History and Severe Atrophic Gastritis Assessed by Pepsinogen Are Risk Factors for the Prevalence of Synchronous Gastric Cancers in Patients with Gastric Endoscopic Submucosal Dissection: A Multicenter Prospective Cohort Study","volume":"58","author":"Hatta","year":"2023","journal-title":"J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/030089160909500103","article-title":"Smoking Status and Gastric Cancer Risk: An Updated Meta-Analysis of Case-Control Studies Published in the Past Ten Years","volume":"95","author":"Chiaradia","year":"2009","journal-title":"Tumori"},{"key":"ref_32","first-page":"197","article-title":"Dose-Response Association between Cigarette Smoking and Gastric Cancer Risk: A Systematic Review and Meta-Analysis","volume":"27","author":"Rota","year":"2025","journal-title":"ResearchGate"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e2020004","DOI":"10.4178\/epih.e2020004","article-title":"Risk Factors for Stomach Cancer: A Systematic Review and Meta-Analysis","volume":"42","author":"Poorolajal","year":"2020","journal-title":"Epidemiol. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0014-2999(97)01483-0","article-title":"Effect of Cigarette Smoke on Ethanol-Induced Gastric Mucosal Lesions: The Role of Nitric Oxide and Neutrophils","volume":"342","author":"Chow","year":"1998","journal-title":"Eur. J. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/00001648-200007000-00012","article-title":"Smoking and Alcohol Intake as Risk Factors for Bleeding and Perforated Peptic Ulcers: A Population-Based Cohort Study","volume":"11","author":"Andersen","year":"2000","journal-title":"Epidemiol. Camb. Mass"},{"key":"ref_36","first-page":"845","article-title":"Alcohol Drinking and Cigarette Smoking: A \u201cPartner\u201d for Gastric Ulceration","volume":"63","author":"Ko","year":"2000","journal-title":"Chin. Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1053\/gast.1997.v113.pm9322514","article-title":"The Potentiating Actions of Cigarette Smoking on Ethanol-Induced Gastric Mucosal Damage in Rats","volume":"113","author":"Chow","year":"1997","journal-title":"Gastroenterology"},{"key":"ref_38","unstructured":"World Health Organization (2018). Global Status Report on Alcohol and Health 2018, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241565639."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3109\/00365528209181085","article-title":"Environmental Factors and Chronic Gastric Ulcer. A Case Control Study of the Association of Smoking, Alcohol, and Heavy Analgesic Ingestion with the Exacerbation of Chronic Gastric Ulcer","volume":"17","author":"Piper","year":"1982","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1053\/j.gastro.2017.10.049","article-title":"Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs","volume":"154","author":"Bjarnason","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1056\/NEJM199209103271101","article-title":"Gastrointestinal Damage Associated with the Use of Nonsteroidal Antiinflammatory Drugs","volume":"327","author":"Allison","year":"1992","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.cgh.2005.10.006","article-title":"Effects of Helicobacter pylori and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Disease: A Systematic Review","volume":"4","author":"Papatheodoridis","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3183","DOI":"10.3748\/wjg.v25.i25.3183","article-title":"Infections with Helicobacter pylori and Challenges Encountered in Africa","volume":"25","author":"Smith","year":"2019","journal-title":"World J. Gastroenterol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/9\/1474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:49:03Z","timestamp":1760035743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/9\/1474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["life15091474"],"URL":"https:\/\/doi.org\/10.3390\/life15091474","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]}}}