| ObjectiveChronic atrophic gastric（CAG）is a typical precancerous lesion,and it is of great importance to investigate its epidemical characteristic.Thus,based on a natural population cohort in the high-risk area of gastric cancer in Fujian Province,we aim to elaborate the prevalence and demographic characteristic of CAG,analyze the metabolic status of patients with CAG,and explore the dietary pattern associated with CAG,providing an epidemiological basis for the prevention and treatment of chronic atrophic gastritis and gastric cancer in the high-incidence area of gastric cancer.MethodsFuqing population-based cohort study was conducted in the Fujian Provincial.The participants who completed the food frequency questionnaire survey,physical examination,and laboratory detection from July to December in2020 were included in the current study.Pepsinogen（PG）was used as the diagnostic criteria of CAG,and its prevalence and distribution characteristics were analyzed.Univariate and multivariate Logistic regression models were established to analyze the relationship between CAG and metabolic indicators,like blood glucose and blood lipids,and so on.Factor analysis was used to identify the main dietary patterns and analyze the characteristics of dietary intake in the population.At last,Logistic regression models were applied to explore the relationship between all dietary patterns and CAG.Results（1）A total of 6634 subjects were included in this study,with 2133（32.2%）males and 4501（67.8%）females.The prevalence of CAG is 16.8%in the total population,and were 13.4%and 18.4%in males and females,respectively.The results of multivariable regression analysis showed that:the prevalence of CAG showed a linear upward trend with the increasing age in the total population(P trend=0.022);the CAG prevalence of high-and middle-income groups is significantly lower than that of the low-income group(P trend=0.024);smokers have a significantly lower risk for CAG than never-smokers（OR=0.72,95%CI:0.54-0.96）;compared with non-tea drinkers,the risk of CAG in habitual tea drinkers was reduced by 23%（OR=0.77,95%CI:0.64-0.93）.The risk of obese people is 1.54（1.20-1.97）times that of people with normal weight.Among male participants,age is significantly negatively related to the prevalence of CAG(P trend<0.001).With the increase of education level,the CAG prevalence was gradually decreased(P trend=0.003);And the risk of obese people is2.39（1.43-3.98）times higher than that of people with normal weight.In the female population,those with a higher family income had a risk of 0.84（0.71-0.99）times lower than that of those with a low income,and those with obesity had a 1.35（1.01-1.80）times risk of that of those with normal weight.（2）After adjusted of gender,age,education level,BMI,tea-drinking,and family history of upper gastrointestinal tumors,the results of multivariate logistic regression showed that high CH,LDL,UA,and CREA groups were related to lower CAG risk,with OR at 0.72（0.61-0.86）,0.72（0.58-0.90）,0.78（0.66-0.92）,and 0.37（0.16-0.84）,when compared to normal groups.However,high ALP and low HDL were associated with high CAG risk,and OR（95%CI）were 1.47（1.14-1.90）and 2.22（1.02-4.86）.In the male population,compared with the normal level,the CAG risk of the low CREA group is 1.84（1.10-3.08）times higher than that normal group,and the risk in the high ALP group is 1.66（1.08-2.54）times higher than the normal.In the female population,the OR（95%CI）of the high UA group was 0.75（0.62-0.90）,when compared to the normal.In addition,the risk of CAG was decreased gradually with the increase of CH and TG.The highest group ORs（95%CI）of CH and TG was 0.76（0.62-0.93）and 0.29（0.09-0.94）when compared to normal groups,respectively.（3）Four main dietary patterns were extracted in the current study through factor analysis,namely:plant-based dietary pattern,animal-based dietary pattern,aquatic product dietary pattern,and processed food dietary pattern.The quintiles of each dietary pattern score were calculated,and all participants were divided into five groups,and multivariate Logistic regression models were used to analyze the relationship between dietary pattern and CAG.And gender,age,education level,BMI,tea-drinking,and family history of upper gastrointestinal tumors were adjusted.In the general population,only processed food dietary patterns（high intake of processed egg/meat/aquatic products,pickled vegetables and soybean paste,and low intake of fresh egg）were related to higher CAG risk.Compared to the first quantile group（the lowest score group）,the ORs（95%CI）of the third and fifth quantiles were 1.33（1.06-1.67）and 1.36（1.08-1.70）,respectively.But no statistical significance was observed between the other four dietary patterns and CAG prevalence.After stratifying by gender,among the male participants,the CAG risk in the fifth group of the plant-based dietary pattern（high intake of fresh fruits/vegetables/tree nuts/dairy products,and low intake of staple foods）was reduced by 58%（OR=0.42,95%CI:0.25-0.73）compared to the first quantile.The risk of CAG in the fifth quintile of processed food dietary pattern was 1.76（1.16-2.67）times higher than that of the first quintile.Among women,the risk of the third quantile group of processed food dietary patterns was 1.34（1.03-1.74）times higher than that of the first quantile.However,the relationship between the other four dietary patterns and chronic atrophic gastritis was all nonsignificant.Conclusion（1）In the population-based cohort established in the gastric cancer high-incidence area of Fujian Province,the CAG prevalence was 16.8%,and women had a higher prevalence than men.In the general population,as age and BMI increase,the CAG prevalence was positively related to age and BMI,while negatively related to income level,smoking,and tea drinking.And their relationship was different in male and female populations.（2）The CAG risk is related to metabolic indexes,the increase of indicator on liver function was related to higher risk,while the increase of blood lipids and renal indicators were related to lower risk.（3）A total of four main dietary patterns were extracted in the cohort population through factor analysis,and they were the plant-based dietary pattern,animal-based dietary pattern,aquatic product dietary pattern,and processed food dietary pattern.Among the general population,only processed food dietary pattern was positively related to CAG.Among men,the plant-based dietary pattern is negatively related to CAG prevalence,and the processed food dietary pattern is positively related to CAG risk. |
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