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Associations between dietary polyphenols and risks of gastric precancerous lesions and cancer
Ma-Tu Li, Ya Zheng, Jin-Yu Zhao, Zheng-Qi Wu, Lin-Zhi Lu, Jie Sun, Qiang Li, Xiao-Chuang Shu, Waleed Q Naji, Jing Yang, Fei-Fei Chen, Xiao-Mei Ma, Hui-Yun Zhang, Fu-Cheng Yang, Li-Li Du, Yan-De Xie, Pan-Wang Du, Wan-Ru Kong, Hao Yuan, Rui Ji, Qing-Hong Guo, Zhao-Feng Chen, Yu-Ping Wang, Yong-Ning Zhou
Ma-Tu Li, Jin-Yu Zhao, Waleed Q Naji, Jing Yang, Fei-Fei Chen, Hui-Yun Zhang, Fu-Cheng Yang, Li-Li Du, Yan-De Xie, Pan-Wang Du, The First Clinical Medical College, Lanzhou University, Lanzhou 730030, Gansu Province, China
Ma-Tu Li, Ya Zheng, Qiang Li, Xiao-Chuang Shu, Waleed Q Naji, Jing Yang, Fei-Fei Chen, Xiao-Mei Ma, Hui-Yun Zhang, Hao Yuan, Rui Ji, Qing-Hong Guo, Zhao-Feng Chen, Yu-Ping Wang, Yong-Ning Zhou, Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
Ma-Tu Li, Ya Zheng, Jing Yang, Fei-Fei Chen, Xiao-Mei Ma, Hui-Yun Zhang, Rui Ji, Qing-Hong Guo, Zhao-Feng Chen, Yu-Ping Wang, Yong-Ning Zhou, Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
Zheng-Qi Wu, Department of Gastroenterology, Gansu Wuwei Liangzhou Hospital, Wuwei 733000, Gansu Province, China
Lin-Zhi Lu, Department of Gastroenterology, Gansu Wuwei Tumor Hospital, Wuwei 733000, Gansu Province, China
Jie Sun, Department of Geriatrics (I), The First Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
Wan-Ru Kong, Department of Infection Management, Gansu Provincial Hospital, Lanzhou 730030, Gansu Province, China
Co-first authors: Ma-Tu Li and Ya Zheng.
Co-corresponding authors: Yu-Ping Wang and Yong-Ning Zhou.
Author contributions: Wang YP and Zhou YN designed the research study; Li Q, Sun J, Shu XC, Ji R, Guo QH, Chen ZF, Wu ZQ, Li MT, and Zheng Y performed the research; Li MT, Zheng Y, Lu LZ, Yuan H, Kong WR, and Zhao JY analyzed the data; Li MT and Zheng Y wrote the manuscript; Chen FF, Yang J, Ma XM, Zhang HY, Naji WQ, Yang FC, Du LL, Xie YD, Li MT, Zheng Y, Yuan H, Kong WR, and Du PW reviewed and edited the manuscript; Zhou YN and Wang YP supervised the study; Li MT and Zheng Y contributed equally to this work as co-first authors; Zhou YN and Wang YP contributed equally to this work as co-corresponding authors; all authors have read and approved the final manuscript.
Supported by the Joint Scientific Research Fund of Gansu Province, No. 23JRRA1487; Lanzhou Science and Technology Program, No. 2023-1-19; Gansu Provincial Department of Education Innovation and Entrepreneurship Education Reform Project, No. 202314-16; and National Natural Science Foundation of China, No. 82160498.
Institutional review board statement: Approval for the study was granted by the Ethics Committee of the First Hospital of Lanzhou University (approval No. LDYYLL2012001).
Informed consent statement: All participants provided written informed consent in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
zhouyn@lzu.edu.cn.
Corresponding author: Yong-Ning Zhou, MD, Professor, Department of Gastroenterology, The First Hospital of Lanzhou University, No. 1 West Donggang Road, Lanzhou 730030, Gansu Province, China.
zhouyn@lzu.edu.cn
Received: December 12, 2025
Revised: January 20, 2026
Accepted: March 16, 2026
Published online: May 28, 2026
Processing time: 159 Days and 15.6 Hours
BACKGROUND
While numerous studies have examined the associations between dietary polyphenol subclasses (i.e., flavonoids, phenolic acids, lignans, and stilbenes) and the risk of gastric cancer (GC), evidence regarding their relationships with gastric precancerous lesions (GPL) and their subtypes [i.e., chronic atrophic gastritis, intestinal metaplasia (IM), and low-grade dysplasia (LGD)] remains extremely limited.
AIM
To investigate the associations between dietary polyphenol subclasses and both GPL subtypes and GC in a high-risk population.
METHODS
This cross-sectional study utilized baseline data from the Wuwei Cohort. The intakes of dietary polyphenol subclasses were estimated using a food frequency questionnaire and the Phenol-Explorer database. Gastric diseases were diagnosed via endoscopic screening followed by pathological confirmation and further classified into three distinct groups: Normal control group, GPL group, and GC group. Logistic regression model and restricted cubic spline (RCS) analyses were employed to assess the associations between dietary polyphenol subclasses and the risks of GPL and GC.
RESULTS
Higher stilbenes intake was associated with lower GPL risk [odds ratio (OR) T3vsT1 = 0.78, 95% confidence interval (CI): 0.67-0.89]. For specific lesions, strong inverse associations were observed in IM and phenolic acids (ORT3vsT1 = 0.75, 95%CI: 0.62-0.91), lignans (ORT3vsT1 = 0.80, 95%CI: 0.66-0.96), and stilbenes (ORT3vsT1 = 0.58, 95%CI: 0.48-0.69). Flavonoids intake was associated with an increased risk of IM (ORperLog2 = 1.13, 95%CI: 1.02-1.25). RCS analyses revealed a reverse U-shaped relationship between flavonoids and LGD risk (P = 0.022). Regarding GC risk, an inverse association for stilbenes (ORT3vsT1 = 0.59, 95%CI: 0.42-0.84; ORperLog2 = 0.92, 95%CI: 0.86-0.97) was observed, and a positive association for flavonoids (ORperLog2 = 1.25, 95%CI: 1.02-1.55). However, these associations were attenuated and became non-significant after comprehensive covariate adjustment.
CONCLUSION
Specific dietary polyphenol subclasses, including stilbenes, lignans, and phenolic acids, are associated with reduced risks of GPL, particularly IM. Flavonoids intake may be associated with increased risks of GPL and GC.
Core Tip: This cross-sectional study based on a natural population cohort in an area with a high incidence of gastric cancer in China shows that dietary polyphenol subclasses, including stilbenes, lignans, and phenolic acids, are associated with reduced risks of gastric precancerous lesions such as chronic atrophic gastritis, intestinal metaplasia, and low-grade dysplasia. This finding highlights that dietary patterns may play an important role in the prevention of gastric cancer in Wuwei, an area with a high incidence of gastric cancer.
