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Kashmiri Diet and Gastric Carcinoma Epidemiology and Risk Factors: a Review

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Kashmiri Diet and Gastric Carcinoma Epidemiology and Risk Factors: a Review International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Kashmiri Diet and Gastric Carcinoma Epidemiology and Risk Factors: A Review Maeena Naman Shafiee1, Dr. Sheikh Mohd Saleem2 1PhD. Research Scholar, Dept. of Food Science and Technology, University of Kashmir, Srinagar, J&K, India. 2Senior Resident, Department of Community Medicine, Government Medical College, Srinagar, J&K, India. Corresponding Author: Maeena Naman Shafiee ABSTRACT Kashmiri population has distinct dietary habits owing to the long winter spells prevalent in the valley which has accustomed the population to preserve the food in the form of smoked, pickled and dried foods. These peculiar dietary habits contribute to the intake of many N-nitroso compounds (NOCs) which are responsible for DNA damage, Cytotoxicity, gene mutation, DNA methylation, and unscheduled DNA synthesis. At the molecular level, these changes are responsible for the pathogenesis of cancer. This paper presents a review of the relation between the Kashmiri diet and gastric carcinomas, highly prevalent in the valley. This study creates an initial study base and enlists the number of potential factors responsible for the alarming rate of gastric carcinoma in the valley. Keywords: Kashmir, Kashmiri diet, gastric cancer, N-Nitrosodimethylamine, dietary habits 1. INTRODUCTION with the non-serious issues that may occur Stomach cancer also known as in the GI tract like a sense of fullness in the gastric carcinoma is an abnormal stomach, difficulties while swallowing, uncontrolled division of cells that form a frequent burps, heartburn, stomach ache, mass in any part of the stomach. This vomiting etc. Cancer at later stages causes process happens slowly and may develop serious symptoms like anemia, black stools, over time. Majority of the people suffering tiredness and fatigue, loss of appetite and from it are usually diagnosed at the stage of weight loss etc. [2] Although the reasons for metastasis. A Study conducted on a large the growth of cancer in some and not in scale in America reported that gastric cancer others is not known, there are certain risk in around 65 % of cases was diagnosed at factors which make some patients more metastasis stage with about 85 % cases prone to gastric cancer. These risk factors being reported when a tumor starts to affect include dietary habits including salty, the lymph nodes. [1] Metastasis is a stage smoked or pickled food, H-Pylori bacterial when cancer starts to spread to other parts infection, tumors in other body parts, from the area where it has started. [2] smokers, people with family history of Majority of stomach cancers are of cancers, people of Asian subcontinent adenocarcinoma type. [2] In this type, the (especially Japan) and Americans, Type-A carcinoma starts from the mucosa layer blood group etc. [2] which produces mucus. This is the fifth Several dietary factors are found to most common type of cancer throughout the be responsible for the occurrence of gastric world. [3] Diagnosis of this type of cancer is carcinoma across the world, when studied in hard since the symptoms are quite relatable detail; A case-control study revealed that International Journal of Health Sciences & Research (www.ijhsr.org) 286 Vol.9; Issue: 4; April 2019 Maeena Naman Shafiee et.al. Kashmiri Diet and Gastric Carcinoma Epidemiology and Risk Factors: A Review diet including high salt, smoked or food that high intake of Brassica Olerecea (Haakh), is poorly preserved, rich in nitrates, nitrites Common picked vegetables, dried smoked are associated with high risk of gastric fish (Hoch gade), dried vegetables and extra carcinoma, [4] this is because of the change spicy spice cakes commonly called as Wur in the gastric environment because of the are found to be one of the reasons for the generation of the carcinogenic N-nitroso increased risk of gastric cancer in the valley. compounds. [5] However some studies [20, 21] revealed in contrast that the intake of a large 2. Review methodology: number of fruits and vegetables can reduce A predefined criteria was set to the risk of cancer in the human body. [6] review the related literature. A thorough Vitamins and minerals like calcium, vitamin search was done on the required literature A and C have a protective effect on the using popular keywords like gastric cancer, mucosa lining that decreases the effect diet, dietary habits of Kashmir, N-nitroso caused by the carcinogenic compounds. [5,6] compounds, carcinogens, and risk factors. A study done in detail reported that Pub med and Google scholar were smokers are 2-3 times more prone to gastric extensively used to collect the data. carcinoma than non-smokers. [6] Reports 3. Epidemiology: also suggest the identification of the E- Around 85 % of cases of gastric Cadherin mutation to avoid the occurrence carcinoma were detected in 2016 which from one generation to another as heredity were mainly in the pancreas followed by non-polyposis colon cancer (HNPCC) duodenum across the world. [22] In North syndrome. [7] Gastric carcinoma has also America, the probability of developing the been associated very strongly to H-Pylori gastric carcinoma is reported to be 1.5%. [22] infection. This infection is found to induce However, the mortality rates in Canada have changes in the gastric mucosa and flora decreased from 21.2 % to 9.1 % in males. resulting in gastric cancer in the human [23] It has been reported that in the United body. [8-11] Apart from this H.Pylori is found States the annual deaths caused by gastric to have an adhering capacity with the Lewis cancer are 14,000. [24] The areas highly blood group antigen which may cause prone to gastric carcinoma include East chronic infection resulting in an increased Asia; areas like China and Japan Eastern risk in patients with Type A blood group. [8] part of Europe, Central America. While the Gastric cancer is 40 % more in Kashmir low-risk areas include Southern Asia, North than any other form of cancer making this Africa, Australia, and New Zealand. [25] three to six times more than that the metro In cultures of the world where food cities of India. [12] Gastric cancer attains the with the high salt intake is consumed gastric position of top five cancers in the valley carcinomas are quite prevalent. Many with a Male: Female ratio of 3.17:1. [13] research studies have proven that salt has a Dietary Habits of the population contribute dampening effect on the body and may to the high gastric cancer prevalence in the cause some serious chronic issues. [26] valley. [14] Many genetic factors and other Studies prove that as per an epidemiological socio-economic factors which are distinct to survey when a Japanese group of nationals each community have a close association migrated from their homeland and changed with the gastric cancer load on the the habit of high salt intake in food, the community. [15-17] Many epidemiological sample revealed low incidences of gastric studies conducted across Asian countries carcinomas. [26] In areas like Hawaii where reveal that high salt intake in the diet is the common dietary intake was that of responsible for this increasing rise in the salted fish the gastric carcinomas wherein gastric Cancer. [18,19] The peculiar dietary high numbers [27] same is the case with habits of the Kashmir valley like intake of Lithuania where a high intake of salted hot salt (alkaline tea; Kashmiri salt tea], mushrooms became a reason for high International Journal of Health Sciences & Research (www.ijhsr.org) 287 Vol.9; Issue: 4; April 2019 Maeena Naman Shafiee et.al. Kashmiri Diet and Gastric Carcinoma Epidemiology and Risk Factors: A Review prevalence of gastric carcinomas. [28] Same 4.1: Sun-dried vegetables (Hukh Suen): results are found for Serbia, [29] Costa Rica Vegetables like turnips, tomatoes, bottle where the most consumed item is of salted gourd, and brinjal are commonly consumed black bean, which reports the highest in the dried form. Turnip is peeled and amount of gastric cancers in the world sliced which is then hung to dry in open air. literature. [30] It is the fifth and seventh most Long thin variety of brinjal is also preserved prevalent disease in the males and females in the same way, sliced lengthwise, it is respectively in India. [3] Certain hung in straight ropes and left to sundry. geographical areas of the country are more Tomatoes are simply sliced and spread on a prone to gastric cancer like the north eastern large surface to sundry. Bottle gourd is the states and the southern areas of India. [31] most preferred and largely consumed dried Although there is a declining trend in the vegetable of the valley which is cleaned and disease all across the globe in certain parts sliced, then left to dry. of India this decline is not prevalent and the It has also been reported that drying state of Jammu and Kashmir especially the vegetables in the sun, exposing to Kashmir valley is one of them. [32,12,20,33,21,34- uncontrolled U.V radiations makes the 36] vegetables more prone to Aflatoxins and In a number of studies done in Fungi which may be detrimental to human Kashmir, it was reported that carcinomas of health. [41] esophagus and stomach account to more 4.2: Brassica oleracea (Haakh): It is the than 57- 60 % of cancer cases in the state most commonly consumed green leafy including Oesophageal and gastric vegetable of the valley, owing to its malignancies. [38,39] A case-control study affordable price people of all economic conducted in Kashmir revealed the effect of strata consume it as a staple diet. These are dietary habits on the increasing numbers of best cooked with a bit of green and red chili gastric carcinomas in the valley which and tastes best when freshly off-stoved.
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