P1341 - Positive Association of Dietary Salt Intake and Gastric Intestinal Metaplasia: A Systematic Review and Meta-analysis

Eleazar E.. Montalvan-Sanchez, MD¹, Dalton A. Norwood, MD², Diego Izquierdo-Veraza, MD¹, Blanca Estefanie. Avalos-Quijano, MS³, Renato Beas, MD⁴, Mirian Ramirez-Rojas, MLIS⁵, Aida Rodriguez-Murillo, MD¹, Bernardo Donery Lopez Samayoa, MD⁶, Tatiana Torres Herman, MD⁷, Douglas Morgan, MD, MPH^7
1Indiana University School of Medicine, Indianapolis, IN; ²UAB Minority Health and Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Universidad Evangélica de El Salvador, Wilmington, NC; ⁴Indiana University, Indianapolis, IN; ⁵Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN; ⁶Johns Hopkins Bloomberg School of Public Health, San Bernardino, CA; ⁷University of Alabama at Birmingham, Birmingham, AL

Introduction: Gastric cancer (GC) is the fourth leading cause of global cancer mortality. Gastric intestinal metaplasia (GIM) is the principal gastric premalignant condition (GPMC) and thought to represent an irreversible histologic point of no return. Dietary salt intake is associated with gastric cancer and is implicated in GIM development and progression. Salt has several carcinogenic effects: the generation of N-nitroso compounds; degradation of the mucosal barrier with inflammation; and increased colonization and inflammation by H. pylori, particularly cagA+ strains. We performed a systematic review and meta-analysis on the association of salt intake and GIM prevalence.

Methods: We used the PubMed Scopus and Web of Science databases, with the PRISMA protocol, through April 2023 to identify epidemiological studies published in English assessing the association of salt consumption and the GIM prevalence. Two independent reviewers assessed study quality/risk for bias using Newcastle-Ottawa Scale (NOS) and extracted descriptive and quantitative data. The pooled OR estimates were calculated, heterogeneity was assessed by the inconsistency index (I2).

Results: The literature search yielded 3522 studies, of which 36 were identified for full-text review, with 13 studies filling the criteria for final analysis including 9237 patients. The odds ratios (ORs) for the association between salt intake and GIM prevalence ranged from 1.01 to 3.50 across the included studies. The weighted average OR was 1.49 (95%; 1.21-1.84). The test of theta (= 0) z-value was 3.75, demonstrating a statistically significant association between salt intake and GIM (p < 0.0002). The heterogeneity analysis revealed a moderate level of heterogeneity, with an I2 value of 55.55%, indicating variations in effect sizes across the studies. The regression-based Egger test (p-value =0.0410) implied potential small-study effects in our meta-analysis.

Discussion: Our findings suggest an association between dietary salt intake and the risk of developing GIM. The association was stronger than that observed in studies with GC as the endpoint. There was no significant difference by geographic region nor by the study design. Salt intake recommendations should be included in overall risk-reduction recommendations (e.g., tobacco, alcohol) in patients with GIM.



Disclosures:


Eleazar E.. Montalvan-Sanchez, MD¹, Dalton A. Norwood, MD², Diego Izquierdo-Veraza, MD¹, Blanca Estefanie. Avalos-Quijano, MS³, Renato Beas, MD⁴, Mirian Ramirez-Rojas, MLIS⁵, Aida Rodriguez-Murillo, MD¹, Bernardo Donery Lopez Samayoa, MD⁶, Tatiana Torres Herman, MD⁷, Douglas Morgan, MD, MPH⁷. P1341 - Positive Association of Dietary Salt Intake and Gastric Intestinal Metaplasia: A Systematic Review and Meta-analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.