High Salt Intake Is Associated with Atrophic Gastritis with Intestinal Metaplasia

Abstract

<b>Background:</b> Although several studies have investigated excessive salt intake as a risk factor for gastric precancerous lesions, such as atrophic gastritis and intestinal metaplasia, the evidence is insufficient to make a conclusion. We evaluated the association between gastric precancerous lesions and salt intake.<b>Methods:</b> From 2008 to 2015, the medical records of 728 subjects who underwent upper gastrointestinal endoscopy and sodium excretion in 24-hour urine tests were retrospectively reviewed. Sixty-six subjects were excluded due to diuretics use (<i>n</i> = 55), diagnosis with a gastric neoplasm (<i>n</i> = 4), or the cases of intestinal metaplasia in the absence of atrophy (<i>n</i> = 7), so 662 subjects were included. Atrophic gastritis and intestinal metaplasia were diagnosed by endoscopic findings. The subjects were grouped into three levels by tertiles of 24-hour urine sodium excretion.<b>Results:</b> A total of 192 (29.0%) had atrophic gastritis without intestinal metaplasia and 112 (16.9%) had atrophic gastritis with intestinal metaplasia. A total of 276 subjects (61.5%) were infected with <i>Helicobacter pylori</i> (<i>H. pylori</i>). In multivariate analyses, <i>H. pylori</i> infection [OR = 14.17; 95% confidence interval (CI), 7.12-28.22) was associated with atrophic gastritis without intestinal metaplasia. Highest levels of sodium excretion (OR = 2.870; 95% CI, 1.34-6.14), heavy smoking (≥20 pack-years) (OR = 2.75; 95% CI, 1.02-7.39), and <i>H. pylori</i> infection (OR = 3.96; 95% CI, 2.02-7.76) were associated with atrophic gastritis with intestinal metaplasia.<b>Conclusions:</b> Our endoscopy-based study suggested that high salt intake could be associated with an increased risk of atrophic gastritis with intestinal metaplasia.<b>Impact:</b> Low salt diet might be helpful to prevent gastric carcinogenesis. <i>Cancer Epidemiol Biomarkers Prev; 26(7); 1133-8. ©2017 AACR</i>.