Journal Article

Dietary factors associated with the progression of gastric intestinal metaplasia (GIM): a multicentre, prospective cohort study in a Western population

Kapteijn, N E A, Honing, J, Anten, M, Spaander, M C W, Schot, I, Doukas, M, Witteman, E M, Ter Borg, F, Capelle, L G, Kuipers, E J, Pluimers, J K F, Holster, I L, Marijnissen, F E, Burger, J P W

2026

Overview

While several dietary factors like high salt intake are linked to progression of Gastric intestinal metaplasia (GIM) to gastric cancer (GC) in high-risk countries, their effect on GIM progression in Western populations remains less clear. This study investigates the influence of dietary factors on GIM progression in a Western population.BACKGROUND AND AIMWhile several dietary factors like high salt intake are linked to progression of Gastric intestinal metaplasia (GIM) to gastric cancer (GC) in high-risk countries, their effect on GIM progression in Western populations remains less clear. This study investigates the influence of dietary factors on GIM progression in a Western population.The PROREGAL study (2009-2024) is a prospective cohort study of GIM patients undergoing surveillance. The Operative Link on Gastric Intestinal Metaplasia (OLGIM) criteria determined GIM stage, with an increase in OLGIM stage reflecting disease progression. Data on family history, medication use, and diet were collected through self-reported questionnaire and by medical records. Multivariate logistic regression was used to identify risk factors for disease progression.METHODSThe PROREGAL study (2009-2024) is a prospective cohort study of GIM patients undergoing surveillance. The Operative Link on Gastric Intestinal Metaplasia (OLGIM) criteria determined GIM stage, with an increase in OLGIM stage reflecting disease progression. Data on family history, medication use, and diet were collected through self-reported questionnaire and by medical records. Multivariate logistic regression was used to identify risk factors for disease progression.A total of 312 GIM patients were included (median age 61 years, 50.3% male, median follow-up 54 months, IQR 36). Progression occurred in 112 patients (35.9%), with six patients (1.9%) developing high-grade dysplasia or GC. High dietary salt consumption (OR 1.67; 95% CI 1.05-2.68, P=0.04), meat ≥6 servings per week (OR 1.25; 95% CI 1.07-1.46, P=0.004) smoking (OR 1.76; 95%CI 1.04-2.68), autoimmune gastritis (OR 2.49; 95%CI 1.04-5.83) and having a positive first-degree family member with GC (OR 2.01; 95%CI 1.20-3.52) were significantly associated with GIM progression. Fish consumption, alcohol intake, and previous H. pylori infection showed no significant association with GIM progression.RESULTSA total of 312 GIM patients were included (median age 61 years, 50.3% male, median follow-up 54 months, IQR 36). Progression occurred in 112 patients (35.9%), with six patients (1.9%) developing high-grade dysplasia or GC. High dietary salt consumption (OR 1.67; 95% CI 1.05-2.68, P=0.04), meat ≥6 servings per week (OR 1.25; 95% CI 1.07-1.46, P=0.004) smoking (OR 1.76; 95%CI 1.04-2.68), autoimmune gastritis (OR 2.49; 95%CI 1.04-5.83) and having a positive first-degree family member with GC (OR 2.01; 95%CI 1.20-3.52) were significantly associated with GIM progression. Fish consumption, alcohol intake, and previous H. pylori infection showed no significant association with GIM progression.Increased consumption of meat and salt is significantly associated with GIM progression, suggesting that dietary risk factors for GIM progression are similar in low- and high-incidence countries.CONCLUSIONIncreased consumption of meat and salt is significantly associated with GIM progression, suggesting that dietary risk factors for GIM progression are similar in low- and high-incidence countries.