Epidemiologic Study of Gastric Cancer in Iran: A Systematic Review

Figures & data

Figure 1 Flowchart of the included eligible studies in systematic review.

Table 1 Incidence Rate of Gastric Cancer in Iran

First Author/ Year (Reference Number)	Province(District)	Type of Study	Sample-Size	ASR^a
Ahmadi (2018)^Citation72	Chaharmahal and Bakhtiari	Retrospective	2918
Aghaei (2013)^Citation73	Tehran	-	4463	-
Almasi (2015)^Citation74	All of Iran	Cross-sectional	35,171	7.1 15.1
Almasi (2016)^Citation75	All of Iran	Cross-sectional	9660	15.2
Amani (2015)^Citation76	Ardabil	Cross-sectional	1056
Amoori (2014)^Citation77	Khuzestan	Retrospective	14,893	M=13.8 F= -
Amori (2017)^Citation78	All of Iran	Retrospective	301,055	M=15.02 F=7.05
Eishi (2016)^Citation79	Western Azerbaijan	Sectional & retrospective	2972	-
Babaei (2009)^Citation80	Ardabil	-	M=727 F=311	M=51.8 F=24.9
Babaei (2005)^Citation81	Semnan		M=936 F=796	M=36.9 F=14.8
Behnampour (2014)^Citation65	Golestan	Case-control	M=107 F=49	13.93
Jenab (2019)^Citation82	All of Iran	Ecological	4484	15.93
Hassanzade (2011)^Citation83	Fars	-	M=46 F=31	M=9.99 F=4.66
Chamanpara (2015)^Citation84	Golestan		1087	0.8–1.2
Haghdoost (2008)^Citation85	kerman	-	1112
Haghigh (1971)^Citation86	Fars		182
Khodadost (2015)^Citation87	Ardabil		857
Sadjadi (2005)^Citation88	Golestan, Mazandaran, Kerman, Ardabil	-	51,000	M=26.1 F=11.1
Khazaei (2018)^Citation89	All of Iran	-	M=5398 F=2353	M=19.1 F=10
Masoompour (2016)^Citation90	Fars		-	M=5.56 F=11.21
Masoompour (2011)^Citation91	Fars	-	M=597 F=273	M=9.2 F=4.4
Kavousi (2015)^Citation93	All of Iran	Ecologic	M=20,882 F=8592
Moradpour (2013)^Citation94	Isfahan	-	2001: Male=190 Female=104	2001: Male=9.9 Female=5.6
			2010: Male=272 Female=162	2010: Male=12.8 Female=7.9
			2015: Male=390 Female=250	2015: Male=14.7 Female=9.5
Khazaei (2016)^Citation8	All of Iran	Ecological	951,594
Fateh (2013)^Citation95	Semnan	-	2240	15.52
Fararouei (2015)^Citation96	Kohgiluyeh and Boyer-Ahmad	Cohort	106	11.08
Keyghobadi (2015)^Citation97	Kerman	Cross-sectional	Male: 2004=671	Male: 2004=74.93
			2005=691	2005=71.43
			2006=915	2006=85.85
			2007=837	2007=79.2
			2008=1070	2008=104.22
			2009=1609	2009=131.61
			Female: 2004=572	Female: 2004=75.69
			2005=554	2005=61.79
			2006=765	2006=82.72
			2007=727	2007=78.88
			2008=851	2008=91.94
			2009=1333	2009=128.26
Faramarzi (2013)^Citation98	fars	Cross-sectional	Male=1652	Male=74.9
			Female=1072	Female=49.8
Mashhadi (2010)^Citation99	Sistan & Blouchestan	-	100	22%
Yasemi (2015)^Citation14	ILAM	Retrospective cross-sectional	307
Mohebbi (2011)^Citation100	Mazandaran	ecologic	2665	Male=Ardabil=49.1
Yavari (2006)^Citation101	Ardabil and Kerman Iranian immigrants (BC Iranians)	-	-	Kerman=10.2
				Female=Ardabil=25.4
				Kerman=5.1
				BC Iranians=6.5
Vakili (2014)^Citation102	Yazd	Cross-sectional	4631	Female: 2005=3.3
				2006=4.8
				2007–4.2
				2008=4.6
				2009=4.3
				Male: 2005=7.2
				2006=8.2
				2007–7.5
				2008=9.4
				2009=8.5
Darabi (2016)^Citation103	All of Iran	-	Male: 2001=1105	Male: 2001=4.18
			2010=5192	2010=17.06
			Female: 2001=484	Female: 2001=2.41
			2010=2238	2010=8.85
Salehiniya (2016)^17	Gilan, Mazandran and Golstan	Cross-sectional	Mazandran=2382
			Gilan=1824
			Golestan=709
Talaiezadeh (2013)^Citation104	Khuzestan	Retrospective	Male=667 Female=322	Male=7.17 Female=2.34
Mohagheghi (2009)^Citation31	Tehran	-	Male=2119 Female=1033	Male=19.7 Female=10.0
Norouzinia (2012)^Citation105	Tehran, Khorasan, Lorestan, Mazandaran, Khuzestan, East Azarbaijan, Kurdestan, and Sistan and Baluchesta	Retrospective	140	Lorestan=10.24
				Tehran=5.01
				Tabriz=2.21
				Zahedan=2.31
				Sanandaj=7.07
				Sari=4.23
				Ahvaz=2.3
				Mashhad=4.48
Askarian (2014)^Citation106	Fars	-	1171	85.04
Sadjadi (2014)^Citation16	Ardabil	Cohort	928
Norouzirad (2018)^Citation107	khozestan	Cross-sectional		M=10.88 F=3.29
Mohammadian (2016)^Citation13	Sistan and Baluchestan	-	255	Male: 2004=0–24 years=0
				25–29 years=1.06
				30–34 years=0
				35–39 years=1.48
				40–44 years=0
				45–49 years=2.0
				50–54 years=3.39
				55–59 years=18.42
				60–64 years=22.61
				65–69 years=11.19
				70–74 years=10.83
				75–79 years=7.47
				>80 years=0
				Female: 2004=0–29 years=0
				30–34 years=1.30
				35–39 years=1.53
				40–44 years=1.69
				45–49 years=6.88
				50–54 years=7.73
				55–74 years=0
				75–79 years=10.46
				>80 years=0
				2005: male=0–24 years=0
				25–29 years=0.97
				30–34 years=1.19
				35–39 years=4.08
				40–44 years=3.17
				45–49 years=0
				50–54 years=6.24
				55–59 years=20.33
				60–64 years=23.76
				65–69 years=10.29
				70–74 years=34.87
				75–79 years=20.63
				80–84 years=40.54
				>85 years=54.38
				Female: 2005=0-19 years=0
				20–24 years=0.82
				25–29 years=1.08
				30–34 years=0
				35–39 years=1.41
				40–44 years=0
				45–49 years=2.11
				50–54 years=2.37
				55–59 years=0
				60–64 years=4.44
				65–69 years=14.77
				70–74 years=5.66
				75–79 years=9.62
				>80 years=0
				2006: 0-24 years=0
				25–29 years=0.97
				30–39 years=0
				40–44 years=12.69
				45–49 years=3.68
				50–54 years=9.36
				55–59 years=6.78
				60–64 years=14.85
				65–69 years=17.15
				70–74 years=29.89
				80–84 years=40.54
				>85 years=0
				Female: 2006=0.14=0
				15–19 years=0.61
				20–24 years=0
				25–29 years=1.08
				30–34 years=0
				35–39 years=2.82
				40–44 years=3.11
				45–49 years=6.3
				50–54 years=4.74
				55–59 years=3.56
				60–64 years=13.33
				65–69 years=0
				70–74 years=11.32
				75–79 years=19.25
				80–84 years=0
				>85 years=29.52
				Male: 2007=0–9=0
				10–14 years=0.58
				15–19 years=0
				20–24 years=0.87
				25–39 years=0
				40–44 years=4.76
				45–49 years=3.68
				50–54 years=15.60
				55–59 years=13.55
				60–64 years=8.91
				70–74 years=39.85
				75–79 years=13.75
				80–84 years=60.80
				>85 years=0
				Female: 2007=0–44 years=0
				45–49 years=4.22
				50–54 years=2.37
				55–59 years=3.56
				60–64 years=0
				65–69 years=4.92
				70–74 years=5.66
				75–79 years=19.25
				80–>85 years=0
Najafi (2011)^Citation108	Kermanshah	-		1993=10.6
				1994=13.8
				1995=8.3
				1996=15.8
				1997=15.5
				1998=5.1
				1999=6.7
				2000=8.7
				2001=7.3
				2002=6.7
				2003=8.5
				2004=10.0
				2005=8.7
				2006=9.1
				2007=9.1
Mousavi (2009)^Citation109	All of Iran	-	2003–2004: Male=3088 Female=1166	2003–2004: Male=11.37 Female=5.20
			2004–2005: Male=3770 Female=1439	2004–2005: Male=13.74 Female=6.42
				2005–2006: Male=15.21 Female=6.89
Enayatrad (2014)^Citation110	All of Iran	-	Male: 2003=3088	Male: 2003=11.37
			2004=3770	2004=13.74
			2005=4212	2005=14.90
			2006=4299	2006=15.24
			2007=4485	2007=15.93
			2008=5398	2008=19.16
			2009=4891	2009=16.01
			Female: 2003=1166	Female: 2003=5.20
			2004=1440 2005=1624	2004=6.42 2005=6.74
			2006=167	2006=6.65
			2007=173	2007=7.38
			2008=2353	2008=10.0
			2009=1995	2009=7.78
Haidari (2012)^Citation111	All ofIran	Cross-sectional	21,348	2000=2.8 (2.7–2.9)
				2001=2.6 (2.5–2.7)
				2002=4.6 (4.4–4.7)
				2003=7.1 (6.9–7.4)
				2004=7.9(7.7–8.1)
				2005=9.1(8.8–9.3)
Hosseintabar Marzoni (2015)^Citation112	Golestan	-	1122
Rastaghi, Tohid (2019)^Citation15	All of Iran	Cross-sectional ecological	M=26,041 F=10,756

Abbreviation: ASR, age standardized rate.

Table 2 The Death Rate of Gastric Cancer in Iran

First Author/Year (Reference Number)	Province (District)	Type of Study	Sex	Sample-Size	Age-Standardized Mortality Rate per 100,000(ASMR)	Death Number and Percent	Death per 100,000 People	RR (Relative Risk)	Cumulative Risk	Annual Mortality Rate/100,000
Ahmadipanah (2019)^Citation113	All provinces in Iran except for Tehran	Ecological study	MF	395,002	-	-	-	RR>1.75
AghamohammadI (2017)^Citation114	All provinces in Iran except for Tehran for 2006 & 2011 Isfahan & Tehran For 2007 & 2011	-	MF	2006–2011=1,172,278	-	-	Ministry of Health And Medical Education: 1385=12.20 1386=11.75 1387=11.31 1388=11.18 1389=11.06 1390=10.17 United Nations: 1385=15.05 1386=15.72 1387=15.47 1388=15.35 1389=14.80 1390=13.56	-
Almasi (2016)^Citation75	All of Iran	Cross-sectional	MF	8247	12.9				1.44
Amoori (2016)^Citation115	All of Iran	cross-sectional	MF	34,950	-	-	2006=11.20 2007=11.75 2008=11.31 2009=11.17 2010=11.06
Babaei (2009)^Citation80	Ardabil	-	MF	M=465 F=206	M=32.2 F=16.3
Pourhoseingholi (2013)^Citation12	All of Iran	-	MF							1995=1.68 1996=3.04 1997=3.38 1998=2.29 1999=5.70 2000=6.04 2001=6.47 2002=9.86 2003=9.67 2004=8.78
Hassan Zade (2011)^Citation83	Fars	-	MF	M=46 F=31	M=11.54 F=4.21
Khorasani (2015)^Citation116	All of Iran	-	MF	M=5665 F=2582	-	M=18.8% F=11.11%
Khazaei (2016)^Citation8	All of Iran	Ecological	MF	723,073			10.2
Moradpour (2013)^Citation94	Isfahan	-	MF	2001: M=116 F=68 2010: M=183 F=97 2015: M=283 F=166	2001: M=7.9 f=4.2 2010: M=9.3 F=5.2 2015: M=10.6 F=6.3
Sadjadi (2005)^Citation88	Golestan, Mazandaran, Kerman, Ardabil	-	MF	7843		6638
Mousavi (2009)^Citation109	All of iran	-	MF				12.0
Nalini (2018)^Citation117	Golestan	Cohort	MF	432		1.39%
Mohammadi (2017)^Citation118	All of Iran	Cross-sectional	MF	514,550	M: 2006=16.7 2011=12.5 F: 2006=9.0 2011=6.9

Note: Malekzadeh (2013),¹¹⁹ cox hazard ratio =1.19.

Table 3 The Prevalence Rate Of Gastric Cancer In Iran

First Author/ Year (Reference Number)	Province(District)	Sample-Size	Sex	Prevalence
Ostadrahimi (2017)^Citation120	East-Azerbaijan	111	MF	36.9%
Islami (2004)^Citation121	Golestan	116	M	Gastric cardia adenocarcinoma=16% Gastric noncardia adenocarcinoma=16%
Eishi (2016)^Citation79	Western Azerbaijan	2972	MF	9.7%
Almasi (2015)^Citation74	All of Iran	35,171	MF	Male: Adenocarcinoma, Nos: 2003==68.39 2004=68.59 2005=65.17 2006=61.60 2007=59.30 2008=61.54
				Signet Ring Cell Carcinoma: 2003=9.42 2004=9.63 2005=9.90 2006=10.26 2007=11.95 2008=9.73
				Adenocarcinoma, Intestinaltype: 2003=6.80 2004=8.51 2005=10.83 2006=12.82 2007=13.94 2008=10.58
				Carcinoma, Diffuse Type: 2003=2.91 2004=3.37 2005=3.96 2006=4.07 2007=3.77 2008=4.87
				Carcinoma, Nos: 2003=2.75 2004=10.9 2005=0.28 2006=1.88 2007=0.91 2008=0.74
				Mucinous adenocarcinoma: 2003=1.91 2004=1.64 2005=2.11 2006=1.88 2007=1.87 2008=1.50 Mucin-Producing Adenocarcinoma: 2003=2.17
				2004=1.86 2005=2.04 2006=1.63 2007=1.56 2008=1.33
				F: Adenocarcinoma, Nos: =62.61 2004=65.60 2005=60.84 2006=55.33 2007=56.08 2008=58.90
				Signet Ring Cell Carcinoma: 2003=11.75 2004=12.44 2005=13.67 2006=13.60 2007=14.01 2008=12.07
				Adenocarcinoma, Intestinaltype: 2003=6.69 2004=6.46 2005=8.93 2006=12.98 2007=11.76 2008=9.14 Carcinoma, Diffuse Type: 2003=4.12 2004=3.75 2005=4.0 2006=5.61 2007=5.71 2008=5.10 Carcinoma, Nos: 2003=3.00 2004=1.46 2005=0.37 2006=1.81 2007=1.38 2008=0.72 Mucinous Adenocarcinoma:2003=1.72 2004=1.95 2005=2.59 2006=2.43 2007=1.67 2008=1.57 Mucin-Producing Adenocarcinoma: 2003=2.57 2004=1.74 2005=1.42 2006=1.37 2007=1.79 2008=1.23
Amani (2015)^Citation20	Ardabil	1056	MF	Male: Ardabi)=73.1% Bilesvar=62.5 Germi=65.7 Kousar=88.9 Khalkhal=74.7 Meshkinshahr=74.3 Naming=74.4 Nir=83.9 Parsabad=84.2 Sarein=100 Other=68.2 Female: Ardabil=26.9 Bilesvar=37.5 Germi=34.3 Kousar=11.1 Khalkhal=25.3 Meshkinshahr=25.7 Naming=16.1 Nir=16.1 Parsabad=15.8 Sarein=0 Other=31.8%
Barekat (1971)^Citation122	Fars	M=131 F=42	MF	M=6.59 F=3.26
Bashash (2011)^Citation123	Ardabil	261	MF	M=70.9% F=28.7%
Pourhoseingholi (2008)^Citation124	Tehran	2674	MF	34.5%
Tabrizchee (1998)^Citation125	Kerman	2881	MF	M=9.70% F=6.30%
Tavoli (2007)^Citation126	Tehran	142	MF	30%
Hajmanoochehri (2013)^Citation127	Tehran	729	MF	64.3
Yasemi (2015)^Citation14	Ilam	307	MF	34.2%
Mohebbi (2008)^Citation92	Mazandaran	1663	MF	44.7%
Khademloo (2018)^Citation128	Mazandaran	1232		2008=20% 2009=23.8% 2010=20% 2011=19.5% 2012=16.7%
Tayebi (2012)^Citation129	Mazandaran	596	MF	4.1%
Nikfarjam (2014)^Citation130	Mashhad	495	MF	10.7%
Hashemi (2017)^Citation131	Mashhad,	30	MF	Intestinal type =90% Diffuse type =10%
Yazdizadeh (2005)^Citation132	Shiraz and the Tehran	1516	MF	Tehran=4% Shiraz=4%
Mehrabian (2010)^Citation133	–	3439	MF
Kadivar (2016)^Citation134	Tehran	147	MF	32.6%
Karami (2014)^Citation135	Khuzestan	273	MF	1.4%
Moradpour (2013)^Citation94	Isfahan	2001: male=366 Female=209	MF
		2010: male=582 female=357
		2015: male=852 female=559
Keyghobadi (2015)^Citation97	Kerman	789	MF	7.45%
Mehrabani (2013)^Citation9	Fars	574	MF	<35age=8.9% 36–44=10.6% 45–54=20.7% 55–64=20.2% 65–75=27.7% >75=11.7%
Malekzadeh (2004)^Citation22	Ardabil	1011	MF	Erythema=68.1% Erosion=10.6 Friability=0.3 Nodularity=4.7 Polyp=0.9 Ulcer gastric=3.0 Ulcer (duodenal)=1.9 Atrophic mucosa=0.2 Raised/thickened area=0.3

Table 4 Risk Factors Associated with Gastric Cancer in Iran

First Author	Province	Sample-Size	Sex	Risk Factors	OR (Odds Ratio)
Islami (2004)^Citation121	Golestan	Gastric cardia=42 Gastric noncardia=40	m	Alcohol
				Smoking
				Nass
				Opium (new user)
				Opium (old user)
				Four risk factors (alcohol, cigarette, nass or opium)
Etemadi (2014)^Citation42	Ardabil, Guilan, Mazandaran, Kordestan, and West Azarbaijan	197	M&F	Blood Type A^+	-
				A^−
				B^+
				O^+
				O^_
				AB^+
				N/A Alcoholconsumpti on(yes)
				Alcoholconsumpti on(NO)
				Alcoholconsumpti on N/A
				Smoking(heavy smoker)
				Smoker
				No smoking
				N/A
				Smoked food Low Moderate High N/A
				Salty food Low Moderate High N/A
				Nitrite Low Moderate High N/A
				Hp Infection YES NO N/A
Amoueian (2018)^Citation47	Khorasan Razavi	Case=56 Control=56	MF	Epstein–Barr virus (EBV)	-
Behnampour (2014)^Citation65	Golestan	M=107 F=49	MF	2.07 (1.14-3.75)	History of smoking
				Unwashed hands after defecation	2.61 (1.43-4.76)
				History of gastric cancer in first-degree relatives	2.46 (1.21–4.99)
				Other cancers (except for gastrointestinal cancer) in first-degree relatives	2.34 (0.92–5.96)
				Other cancers (except for gastrointestinal cancer) in second-degree relatives	4.38 (1.14-6.79)
				History of X-ray dye exposure	1.56 (0.85–2.85)
				History of CT scan encounter	2.32 (1.21-4.44)
				Charred flesh	1.65 (0.99-2.88)
				Irregular lunch-time	3.96 (0.96-6.32)
				Achalasia	76.97 (28.35-208 .92)
				Helicobacter pylori	18.58 (1.63- 211.52)
				Gastric ulcer	2.71 (1.15-6.36)
				Low mobility and lack of appropriate activities	4.78 (1.34–16.99)
Boreiri (2013)^Citation136	Ardabil	1011	MF	Age (years) 51–60
				2:61
				Family history
				Positive smoking
				History Histological finding (Atrophic gastritis)
				(Intestinal metaplasia)
				Gastric ulcer
Pakseresht (2011)^Citation60	Ardabil	Case=286 Control=304	MF	Total fat intake	1.33 (1.12–1.57)
				Carbohydrate (per 50 g)	1.00 (0.88– 1.13)
				Selenium (per 50 lg)	1.11 (0.80–1.54)
				Protein (per 10 g)	0.87 (0.76–0.99)
				Vitamin C (per 10 mg)	0.82 (0.76–0.87)
				Vitamin E (per 10 mg)	0.67 (0.44–1.03)
				0.37 (0.25–0.56)	Iron (per 5 mg)
				Zinc (per 5 mg)	0.47 (0.32–0.70)
				Energy (per 100 kcal)	0.99 (0.97–1.02)
Daneshi-Maskooni (2017)^Citation36	Tehran	Case=120 Control=120	MF	Food insecurity	2.57 (1.41- 4.66)
				Low economic level	2.42 (1.23- 4.76)
				Family history	1.98 (1.03- 3.80)
Safaee (2012)^Citation43	Tehran	746	MF	Family history	2.12 (1.72 – 3.28)
Ebrahim Tahaei (2011)^Citation50	Tehran	Case=201 Control=219	MF	HTLV-1 antibodies
Sadjadi (2014)^Citation16	Ardebil	928	MF	Family history
				Cigarette smoking
				Hookah smoking
				Opium use
				Salt intake >6 gr/day
Moghimi-Dehkordi (2011)^Citation137	Tehran	FDR=113 SDR=180	MF	Having a family history	-
Zendehdel (2010)^Citation138	Tehran	808	MF	Family history
Faghihloo (2014)^Citation46	Tehran	90	MF	Epstein-Barr virus (EBV)
Mashhadi (2009)^Citation56	Sistan & Blouchestan	100	MF	Family history smoking and tobacco H. pylori infection
Naghibzadeh Tahami (2014)^Citation32	Kerman	89	MF	Opium use	3.0(1.6–5.6)
				Amount of daily use (>median)	13.0 (4.2 -41.9)
				≤median	5.5 (1.0– 28.4)
				Duration (>median)	10.5 (2.4–46.1)
				≤median	6.8 (1.7–26.8)
				Cumulative use of Opium (>median)	9.2 (2.5–33.7)
				≤median	7.3 (1.2–43.0)
				Cigarette smoking Amount of daily use (>median)	1.4 (0.8–2.3) 1.9 (0.7–5.2)
				≤median	0.8 (0.2 –2.8)
				Duration (>median)	1.2 (0.3–4.2)
				≤median	1.5 (0.5–4.2)
				Cumulative use of smoking (>median)	2.4 (0.8–7.2)
				≤median	1.0 (0.2–3.8)
				Alcohol	1.2 (0.3–.4.4)
Pourfarzi (2004)^Citation53	Ardabil	Case=217 Control=394	MF	Tobacco	0.90 (0.54–1.49)
				Cigarette	0.87 (0.52–1.46)
				Hubble-bubble	1.14 (0.29–4.42)
				Current smoker	0.71 (0.41–1.25)
				Ex-smoker	1.40 (0.63–3.12)
				Age at start (years)<20 20–29 >30	0.54 (0.22–1.29) 1.28 (0.65–2.54) 0.75 (0.36–1.54)
				Average cigarette daily >20 <20	0.67 (0.35–1.30) 1.07 (0.57–1.99)
				Total smoking years–>35 21-35 <20	0.87 (0.45–1.70) 1.11 (0.51–2.46) 0.61 (0.26–1.47)
				Non-filter Filtered Both equally	0.99 (0.23–4.31) 0.86 (0.51–1.47) 0.71 (0.15–3.41)
				Smoke inhalation (Deeply) Moderately or slightly	0.51 (0.27–0.99) 1.90 (0.91–4.01)
				Alcohol	2.03 (0.44–9.31)
				Agriculture	1.96 (0.95–4.01)
				Manufacturing	0.80 (0.25–2.58)
				Construction	1.78 (0.67–4.76)
				Wholesale and retailer	1.32 (0.39–4.49)
				Raw vegetables (3 times/week) (1-2 times/week)	2.08 (1.13–3.82) 1.56 (0.89–2.73)
				Yellow-orange vegetables (3 times/week) 1–2	1.78 (0.81–3.89) 2.07 (1.15–3.70)
				Garlic (3 times/week) (1–2 times/week)	0.35 (0.13–0.95) 0.48 (0.25–0.91)
				Onion≥once per day (3–4 times/week)	0.34 (0.19–0.62) 1.28 (0.73–2.23)
				Fresh fruits≥3 times/week 1–2 times/week	0.89 (0.43–1.86) 0.44 (0.22–0.89)
				Citrus fruits (≥3 times/week) 1–2 times/week	0.31 (0.17–0.59) 0.18 (0.10–0.33)
				Juice≥ once/week	1.29 (0.73–2.29)
				Red meat≥ once/day 3–4/week	3.40 (1.79–6.46) 2.20 (1.26–3.85)
				Fresh fish≥ once/week	0.37 (0.19–0.70)
				Chicken≥once/day 3–4/week	0.93 (0.39–2.20) 1.40 (0.80–2.42)
				Dairy products ≥once/day 3–4/week	2.28 (1.23–4.22) 3.77 (1.92–7.42)
				Cheese≥once/day 3-4/week	1.16 (0.54–2.51) 1.00 (0.39–2.56)
				Smoked meats≥once/month	0.91 (0.40–2.09)
				Smoked fish≥once/month	1.09 (0.63–1.89)
				Processed meats≥once/month	1.14 (0.55–2.37)
				Salted fish≥once/month	1.08 (0.57–2.05)
				Pickled vegetables≥once/week	1.47 (0.84–2.58)
				Beans> once/week	1.04 (0.65–1.66)
				Sweets≥ once/week	0.70 (0.38–1.29)
				Seeds ≥once/month	0.96 (0.37–2.46)
				Salt preference	3.10 (1.88–5.10)
				Strength of tea	2.64 (1.45–4.80)
				Warmth of teaHot	2.85 (1.65–4.91

Table 5 Genes Associated with Gastric Cancer in Iran

First Author(Year)(Reference Number)	Gene
Kulsom Ahmadi (2017)^Citation139	DNMT3B −579 G>T
Shirin Azarbarzin (2017)^Citation140	miR-383
Shirin Azarbarzin (2016)^Citation67	miR-299-5p
Fatemeh Azarkhazin (2017)^Citation141	Casp8 and Apaf1
Ramin Azarhoush (2008)^Citation142	p53
Malek H. Asadi (2010)^Citation143	OCT4
Ahmad Ismaili (2015)^Citation144	IL-1B+3954
Saeed Mahboubi Aghdam (2014)^Citation145	oipA and iceA2
Hassan Akrami (2016)^Citation146	PI3K/Akt1 and p38MAPK
Sakineh Amoueian (2015)^Citation147	CD56, CD68, CD117 and CD1a
Mohammad Amini (2019)^Citation148	GHSR DNA
Mostafa Iranpour (2019)^Citation149	PI3KCA
Nooshin Ayremlou (2015)^Citation150	miR-107
Ali Basi (2012)^Citation151	HER2
Nader Bagheri (2013)^Citation71	IL-18 mRNA
Vahid Bagheri (2019)^Citation152	mRNA
Nader Bagheri (2014)^Citation153	TLR-4
Nader Bagheri (2018)^Citation154	MMP-3 and MMP-9
Seyedeh Zahra Bakhti (2015)^Citation154	vacA 3ʹ-end
Gholam Basati (2017)^Citation155	PPARγ
Zeinab Basiri (2014)^Citation156	vacA d1
Ali Bahadori (2017)^Citation157	cagPAI and vacA
Ali Bahadori (2017)^Citation158	cagPAI and vacA
Bahari (2015)^Citation159	MIR17HG
Mohammadreza Beheshtizadeh (2017)^Citation160	G3BP1 and VEZT
Shahab Bohlooli (2012)^Citation161	KYSE30
Modjtaba Emadi Baygi (2012)^Citation162	MTDH
Sanaz Savabkar (2013)^Citation163	PD-1.5C/T (rs2227981, +7785)
Ghasem Janbabai (2015)^Citation164	EGFR, ErbB2 and MET
Naser Jafargholizadeh (2017)^Citation165	LC3 mRNA
Fereshteh Jafar (2008)^Citation166	vacA
Milad Javanbakht (2017)^Citation167	Oct-4 and MUC5AC
Fereshteh Jeivad (2012)^Citation168	tyrosine kinas
Mina Rezaee Cherati (2017)^Citation169	N58E59
Nasim Hafezi (2015)^Citation170	CD1d
Maryam Habibzadeh (2017)^Citation171	TLR2-196 to -174 ins/del, Arg753Gln and Arg677Trp
Afshin Habibi (2015)^Citation172	CD34
Asghar Hosseinzadeh (2016)^Citation173	mRNA
N. R. Hussein (2010)^Citation174	dupA
Mohammad Reza Haghshenas (2009)^Citation175	(IL)-18
Khatoon Heidari (2017)^Citation176	BabA2, Hpa
Abdulkuddous Heydari-Mehrabadi (2018)^Citation177	ASIC1 and IL-6
Fatemeh Khatami (2009)^Citation178	DNA methyltransferase 1
Malihea Khaleghian (2015)^Citation179	C-MYC
Mitra Khalili (2015)^Citation180	miR-302, miR-145, SOX2, c-MYC, and P21
Mitra Khalili (2012)^Citation181	Mir-302b
Maryam Daneshpour (2018)^Citation182	miR-106a and let-7a
Zohreh Salehi (2017)^Citation183	miRNAs
Sabahi (2010)^Citation184	MDR1
ahra Sedarat (2018)^Citation185	HopQ and SabA
Negar Souod (2013)^Citation186	cagA and vacA
Reza Safaralizadeh (2017)^Citation187	miR-216a and miR-217
Amin Talebi Bezmin Abadi (2011)^Citation188	cagA, homA, and homB
Amin Talebi Bezmin Abadi (2012)^Citation189	dupA
Amin Talebi Bezmin Abadi (2013)^Citation190	babA2
Saeid Abediankenari (2013)^Citation191	EGFR
Esmat Abdi (2016)^Citation192	babA2
Rana Ezzeddini (2019)^Citation193	HIF-1α and SREBP-1c
Hosein Effatpanah (2015)^Citation194	mir-21 and mir-221
Akbar Oghalaie (2016)^Citation195	HP0175
Hossein Dabiri (2017)^Citation196	vacA, cagA, cagE, oipA, iceA, babA2 and babB
Dardaei Alghalandis (2009)^Citation197	CEA
L. Dardaei (2011)^Citation198	CEA, CK20, TFF1 and MUC2
Mehdi Nikbakht Dastjerdi (2015)^Citation199	PLC/PRF5
Masoumeh Douraghi (2009)^Citation200	vacA intermediate region cagA Anti-VacA
Mahboobeh Razmkhah (2013)^Citation201	SDF-1alpha G801A
Masoumeh Rostami (2013)^Citation202	H-ras
Ali Zare (2018)^Citation203	miR-335, miR-124, miR-218 and miR-484
Ali Zare (2019)^Citation204	miR-155-5p, miR-15a, miR-15b, and miR-186
Seiran Zandi (2018)^Citation205	sirt2
Alireza Sadjadi (2013)^Citation206	Serum Ghrelin
Iraj Saadat (2001)^Citation207	GSTM1 and GSTT1
Azam Soleimani (2016)^Citation208	miR-146a
Sareh Sohrabi (2017)^Citation209	PTEN and CDKN1C/p57kip2
Zahra Shahhoseini (2016)^Citation210	rs3130932
Samaneh Saberi (2012)^Citation211	MTHFR C677T
Zeinab Imani-Saber (2015)^Citation212	PML
Mohammad Masoudi (2009)^Citation213	GSTM1 GSTO2 GSTT1
Mehdi Moghanibashi (2012)^Citation214	TFF1
Meysam Moghbeli (2014)^Citation215	hMLH1 and E-Cadherin
Meysam Moghbeli (2019)^Citation216	ErbB1 and ErbB3
Sharareh Mokmeli (2016)^Citation217	ERCC1 C8092A
Zahra Malek-Hosseini (2015)^Citation218	IL-17A
Maryam Mansoori (2015)^Citation219	ABCB1
Seyedeh Habibeh Mirmajidi (2015)^Citation220	bcl2
Rouhallah Najjar Sadeghi (2010)^Citation221	p53
Nowruz Najafzadeh (2015)^Citation222	CD44
Seyedeh Elham Norollahi (2017)^Citation223	WNT16
Mina Noormohammad (2016)^Citation224	miR-222
Parvaneh Nikpour (2013)^Citation225	MSI1
Parvaneh Nikpour (2014)^Citation226	EYA1
Parvaneh Nikpour (2012)^Citation227	ZFX
Mohammadreza Hajjari (2013)^Citation228	SUZ12
Akbar Hedayatizadeh-Omran (2018)^Citation229	P53
Abolghasem Hadinia (2007)^Citation230	CTLA-4
Alireza Andalib (2013)^Citation231	anti-CCR5, anti-CXCR3, anti-CCR3 and anti-CCR4
Roya Kishani Farahani (2015)^Citation232	IGF-1
Shirin Farjadian (2018)^Citation233	HLA-G
Mahdie Hemati (2019)^Citation234	Q192R and L55M
Sahar Honarmand-Jahromy (2015)^Citation235	CagA EPIYA-C
Saeid Latifi-Navid (2013)^Citation236	vacA d1/-i1
Batool Mottaghi (2016)^Citation236	vacA i
M. Motovali-Bashi (2015)^Citation238	GT-repeat
Mojtahedi (2010)^Citation239	p53
Maedeh Mohsenzadeh (2017)^Citation240	RAR-β
Saghar Mohammadi (2017)^Citation241	SIRT3
Farideh Mohammadian (2016)^Citation242	miR-18a, miR-21 and miR-221
Ashraf Mohamadkhani (2013)^Citation243	Pepsinogen I, Pepsinogen II
Mohammadi (2015)^Citation244	mRNA
Seyed-Hamid Madani (2015)^Citation245	Her2-neu
Mohammad-Taher Moradi (2014)^Citation246	p53,MDM2 SNP309
Mohammad-Taher Moradi (2015)^Citation247	MnSOD Val-9Ala
Mohammad-Taher Moradi (2017)^Citation248	GPX1 Pro198Leu
Hamid Ghaedi (2018)^Citation249	miRNAs
Nasrin Gharaati-Far (2017)^Citation169	cationic lipids-mediated
Ghalandary M (2015)^Citation250	CBX8
Seyed Mohammad Hossein Kashf (2015)^Citation251	IL-16
Dor Mohammad Kordi Tamandani (2015)^Citation252	THRβ
Elham Kalantari (2017)^Citation253	Lgr5, DCLK1
Behnam Kamalidehghan (2006)^Citation254	DmtDNA4977
Sholeh Kiani (2018)^Citation255	CDX1 and CDX2
Pegah Larki (2018)^Citation256	miR-21, miR-25, miR-93, and miR-106b
Rajeeh Mohammadian Amiri (2016)^Citation257	NOD1 and NOD2
Seyedeh Habibeh Mirmajidi (2016)^Citation258	Bcl2
Dor Mohammad Kordi-Tamandani (2014)^Citation259	CTLA4

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