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darkvader

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"While our study based on a large cohort suggests that always adding salt to food at table is also associated with a higher risk of gastric cancer in Western populations, it has several limitations. Case numbers in our study were not sufficient to evaluate the influence of potential modifiers such as sex, age, ethnicity, H. pylori infection, or smoking status. Analyses stratified by anatomical cancer site were restricted due to low case numbers. While we found no heterogeneity in risk associations between added salt intake and cardia vs. non-cardia gastric cancer, larger studies are needed to assess potential differences across cancer subtypes. H. pylori status was ascertained from self-reported and hospital impatient data as data from stool or breath samples were not available in UK Biobank; with 0.3% estimated prevalence among UK Biobank participants vs. 35.5% estimated UK prevalence of H. Pylori infection it was most likely underestimated [37]. Also, due to the observational nature of our study residual confounding cannot be excluded. Our ancillary analyses on urinary sodium and gastric cancer were restricted to spot urine samples, which have been shown to lead to biased associations with cardiovascular diseases compared to repeated 24-h urine samples [28, 29], including one study in UK Biobank that did not show significant associations between spot urine sodium and cardiovascular disease risks [38]. In addition, the case number available for these analyses was rather low. Next, while we did not have data on salt intake via foods for the full UK Biobank cohort, although the present analyses in a subset of participants with detailed dietary data indicate that individuals, who add more salt are also more likely to consume foods with higher sodium content; thus, and given that dietary salt intake is prone to measurement error, true associations between salt intake and gastric cancer risk could be stronger than those observed in this study. Finally, our findings cannot be generalized to the general UK population due to voluntary participation and age restriction of the UK Biobank cohort."

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