Development and validation of a nomogram incorporating dietary factors for predicting Helicobacter pylori-negative early gastric cancer risk

doi:10.3748/wjg.v31.i46.112791

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World J Gastroenterol. Dec 14, 2025; 31(46): 112791
Published online Dec 14, 2025. doi: 10.3748/wjg.v31.i46.112791

Table 1 Comparison of clinical characteristics between the Helicobacter pylori-negative early gastric cancer and the Helicobacter pylori-negative-control groups in the training set, n (%)

	HpN-control group (n = 207)	HpN-EGC group (n = 209)	P value
Sex			< 0.001
Male	80 (38.6)	136 (65.1)
Female	127 (61.4)	73 (34.9)
Age, years	53.0 (42.0, 61.0)	63.0 (57.0, 68.0)	< 0.001
BMI (kg/m²)	24.0 (21.8, 26.3)	23.7 (21.5, 25.9)	0.499
Smoking¹			< 0.001
Yes	21 (10.1)	101 (48.3)
No	186 (89.9)	108 (51.7)
Drinking¹			< 0.001
Yes	33 (15.9)	88 (42.1)
No	174 (84.1)	121 (57.9)
Educational level			< 0.001
High school or above	178 (86.0)	127 (60.8)
Below high school	29 (14.0)	82 (39.2)
Clinical symptoms			0.001
Yes	130 (62.8)	163 (78.0)
No	77 (37.2)	46 (22.0)
Hypertension			< 0.001
Yes	38 (18.4)	77 (36.8)
No	169 (81.6)	132 (63.2)
Diabetes			< 0.001
Yes	9 (4.3)	37 (17.7)
No	198 (95.7)	172 (82.3)
Hyperlipidemia			0.626
Yes	32 (15.5)	36 (17.2)
No	175 (84.5)	173 (82.8)
Cardiac and cerebral diseases			< 0.001
Yes	12 (5.8)	50 (23.9)
No	195 (94.2)	159 (76.1)
Digestive comorbidities			< 0.001
Yes	83 (40.1)	179 (85.6)
No	124 (59.9)	30 (14.4)
Family history of tumors			0.214
Yes	53 (25.6)	65 (31.1)
No	154 (74.4)	144 (68.9)
CCI	0.39 ± 0.70	0.92 ± 1.11	< 0.001
Aspirin²			0.365
Yes	6 (7.9)	14 (12.0)
No	70 (92.1)	103 (88.0)
Clopidogrel²			0.170
Yes	0 (0.0)	5 (4.3)
No	76 (100.0)	111 (95.7)
Metformin²			0.003
Yes	1 (1.3)	16 (13.8)
No	75 (98.7)	100 (86.2)
Corticosteroids²			1.000
Yes	1 (1.3)	2 (1.7)
No	75 (98.7)	115 (98.3)
PPI²			0.020
Yes	10 (4.8)	23 (11.0)
No	197 (95.2)	186 (89.0)
Hard food			< 0.001
Occasional	204 (98.6)	166 (79.4)
Frequent	3 (1.4)	43 (20.6)
Fried food			0.055
Occasional	192 (92.8)	182 (87.1)
Frequent	15 (7.2)	27 (12.9)
Spicy food			< 0.001
Occasional	189 (91.3)	155 (74.2)
Frequent	18 (8.7)	54 (25.8)
Smoked food			< 0.001
Occasional	200 (96.6)	142 (67.9)
Frequent	7 (3.4)	67 (32.1)
Hot food			0.013
Occasional	156 (75.4)	134 (64.1)
Frequent	51 (24.6)	75 (35.9)
Moldy food			1.000
Occasional	207 (100.0)	208 (99.5)
Frequent	0 (0.0)	1 (0.5)
Onion and garlic			0.005
Occasional	46 (22.2)	25 (12.0)
Frequent	161 (77.8)	184 (88.0)
Legumes			< 0.001
Occasional	81 (39.1)	134 (64.1)
Frequent	126 (60.9)	75 (35.9)
Nuts			< 0.001
Occasional	138 (66.7)	174 (83.3)
Frequent	69 (33.3)	35 (16.7)
Coarse grains			0.522
Occasional	135 (65.2)	130 (62.2)
Frequent	72 (34.8)	79 (37.8)
Meat, egg, and milk			0.617
Occasional	16 (7.7)	19 (9.1)
Frequent	191 (92.3)	190 (90.9)
Fruits and vegetables			0.988
Occasional	5 (2.4)	4 (1.9)
Frequent	202 (97.6)	205 (98.1)

¹Smoking or drinking now or having been smoking or drinking for more than 1 year.

²Long term use of drugs refers to using for more than 1 year.

CCI: Charlson comorbidity index; BMI: Body mass index; PPI: Proton pump inhibitors; HpN: Helicobacter pylori-negative; EGC: Early gastric cancer.

Full Size Table

Table 2 Univariate and multivariate analyses of clinical characteristics between the Helicobacter pylori-negative early gastric cancer and the Helicobacter pylori-negative-control groups

Characteristics	Univariate			Multivariate
Characteristics	OR	95%CI	P value	OR	95%CI	P value
Sex	0.34	0.23-0.50	< 0.001	0.55	0.12-2.54	0.446
Female vs male
Age, years	1.11	1.08-1.13	< 0.001	1.13	1.05-1.22	0.001
Smoking¹	8.28	4.98-14.33	< 0.001	3.79	0.74-21.96	0.119
Yes vs no
Drinking¹	3.83	2.44-6.15	< 0.001	2.23	0.47-10.60	0.308
Yes vs no
Educational level	0.25	0.15-0.40	< 0.001	0.55	0.15-1.87	0.342
Above vs below high school
Clinical symptoms	2.10	1.37-3.25	< 0.001	1.76	0.53-6.12	0.359
Yes vs no
Hypertension	2.59	1.66-4.10	< 0.001	0.98	0.30-3.10	0.971
Yes vs no
Diabetes	4.73	2.32-10.70	< 0.001	1.93	0.35-11.82	0.456
Yes vs no
Cardiac and cerebral diseases	5.11	2.72-10.36	< 0.001	3.87	0.93-18.24	0.070
Yes vs no
Digestive comorbidities	8.91	5.60-14.55	< 0.001	17.55	4.36-96.25	< 0.001
Yes vs no
CCI	1.94	1.53-2.50	< 0.001	1.36	0.70-2.86	0.386
Metformin²	12.00	2.37-218.98	0.017	1.60	0.07-76.8	0.778
Yes vs no
PPI²	2.24	1.16-5.48	0.023	2.26	0.47-11.79	0.317
Yes vs no
Hard food	17.61	6.28-73.58	< 0.001	17.97	0.24-205.54	0.992
Frequent vs occasional
Spicy food	3.66	2.10-6.65	< 0.001	1.14	0.24-6.05	0.872
Frequent vs occasional
Smoked food	13.48	6.42-33.06	< 0.001	19.00	1.75-453.77	0.035
Frequent vs occasional
Hot food	1.71	1.12-2.63	0.013	4.19	1.10-18.41	0.043
Frequent vs occasional
Onion and garlic	2.10	1.25-3.62	0.006	4.31	0.95-23.22	0.068
Frequent vs occasional
Legumes	0.36	0.24-0.53	< 0.001	0.30	0.09-0.89	0.033
Frequent vs occasional
Nuts	0.40	0.25-0.64	<0.001	0.14	0.037-0.48	0.003
Frequent vs occasional

¹Smoking or drinking now or having been smoking or drinking for more than 1 year.

²Long term use of drugs refers to using for more than 1 year.

CCI: Charlson comorbidity index; PPI: Proton pump inhibitors; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Table 3 Characteristic analysis of the Helicobacter pylori eradication control vs early gastric cancer groups and Helicobacter pylori-naive control vs early gastric cancer groups

Characteristics	H. pylori eradication control group, n = 47	H. pylori eradication EGC group, n = 51	P value	H. pylori-naive control group, n = 248	H. pylori-naive EGC group, n = 247	P value
Sex			< 0.001			< 0.001
Male	17 (36.2)	39 (76.5)		96 (38.7)	169 (68.4)
Female	30 (63.8)	12 (23.5)		152 (61.3)	78 (31.6)
Age, years	46.23 ± 11.27	62.41 ± 8.31	< 0.001	52.71 ± 12.49	63.85 ± 8.73	< 0.001
BMI (kg/m²)	23.74 ± 3.81	23.21 ± 2.78	0.432	24.34 ± 3.62	24.03 ± 3.58	0.339
Smoking¹			< 0.001			< 0.001
Yes	7 (14.9)	30 (58.8)		24 (9.7)	125 (50.6)
No	40 (85.1)	21 (41.2)		224 (90.3)	122 (49.4)
Drinking¹			< 0.001			< 0.001
Yes	6 (12.8)	27 (52.9)		43 (17.3)	106 (42.9)
No	41 (87.2)	24 (47.1)		205 (82.7)	141 (57.1)
Educational level			< 0.001			< 0.001
High school or above	45 (95.7)	31 (60.8)		209 (95.7)	146 (59.1)
Below high school	2 (4.3)	20 (39.2)		39 (4.3)	101 (40.9)
Clinical symptoms			< 0.001			0.032
Yes	20 (42.6)	45 (88.2)		165 (66.5)	186 (75.3)
No	27 (57.4)	6 (11.8)		83 (33.5)	61 (24.7)
Hypertension			0.099			< 0.001
Yes	8 (17.0)	35 (68.6)		47 (19.0)	98 (39.7)
No	39 (83.0)	16 (31.4)		201 (81.0)	149 (60.3)
Diabetes			0.114			< 0.001
Yes	1 (2.1)	6 (11.8)		11 (4.4)	49 (19.8)
No	46 (97.9)	45 (88.2)		237 (95.6)	198 (80.2)
Hyperlipidemia			0.889			0.984
Yes	6 (12.8)	7 (13.7)		41 (16.5)	41 (16.6)
No	41 (87.2)	44 (86.3)		207 (83.5)	206 (83.4)
Cardiac and cerebral diseases			0.094			< 0.001
Yes	2 (4.3)	8 (15.7)		10 (4.0)	67 (27.1)
No	45 (95.7)	43 (84.3)		238 (96.0)	180 (72.9)
Digestive comorbidities			< 0.001			< 0.001
Yes	17 (36.2)	44 (86.3)		106 (42.7)	181 (73.3)
No	30 (63.8)	7 (13.7)		142 (57.3)	66 (26.7)
Family history of GC			0.830			0.156
Yes	12 (25.5)	14 (27.5)		64 (25.8)	169 (68.4)
No	35 (74.5)	37 (72.8)		184 (74.2)	78 (31.6)
CCI	0.40 ± 0.68	0.90 ± 1.17	0.014	0.38 ± 0.73	0.95 ± 1.08	< 0.001
Aspirin²			0.672			0.015
Yes	3 (23.1)	4 (16.0)		4 (4.4)	21 (14.4)
No	10 (76.9)	21 (84.0)		87 (95.6)	125 (85.6)
Metformin²			0.538			0.001
Yes	0 (0.0)	2 (8.0)		1 (1.1)	19 (13.1)
No	13 (100.0)	23 (92.0)		90 (98.9)	126 (86.9)
Corticosteroids²			0.342			0.301
Yes	1 (7.7)	0 (0.0)		0 (0.0)	4 (2.7)
No	12 (92.3)	25 (100.0)		91 (100.0)	142 (97.3)
PPI²			0.094			0.129
Yes	45 (95.7)	43 (84.3)		11 (4.4)	228 (92.3)
No	2 (4.3)	8 (15.7)		237 (95.6)	19 (7.7)
Hard food			0.057			< 0.001
Occasional	47 (100.0)	46 (90.2)		244 (98.4)	204 (82.6)
Frequent	0 (0.0)	5 (9.8)		4 (1.6)	43 (17.4)
Fried food			0.025			0.066
Occasional	37 (78.7)	48 (94.1)		230 (92.7)	217 (87.9)
Frequent	10 (21.3)	3 (5.9)		18 (7.3)	30 (12.1)
Spicy food			0.111			< 0.001
Occasional	41 (87.2)	38 (74.5)		225 (90.7)	195 (78.9)
Frequent	6 (12.8)	13 (25.5)		23 (9.3)	52 (21.1)
Smoked food			0.019			< 0.001
Occasional	44 (93.6)	39 (76.5)		240 (96.8)	177 (71.7)
Frequent	3 (6.4)	12 (23.5)		8 (3.2)	70 (28.3)
Hot food			0.047			0.037
Occasional	38 (80.9)	32 (62.7)		184 (74.2)	162 (65.6)
Frequent	9 (19.1)	19 (37.3)		64 (25.8)	85 (34.4)
Onion and garlic			0.475			< 0.001
Occasional	10 (21.3)	8 (15.7)		61 (24.6)	28 (11.3)
Frequent	37 (78.7)	43 (84.3)		187 (75.4)	219 (88.7)
Legumes			0.002			< 0.001
Occasional	16 (34.0)	33 (64.7)		99 (39.9)	161 (65.4)
Frequent	31 (66.0)	18 (35.3)		149 (60.1)	85 (34.6)
Nuts			0.035			< 0.001
Occasional	31 (66.0	43 (84.3)		176 (71.0)	212 (85.8)
Frequent	16 (34.0)	8 (15.7)		72 (29.0)	35 (14.2)
Coarse grains			0.756			0.177
Occasional	30 (63.8)	31 (60.8)		168 (67.7)	153 (61.9)
Frequent	17 (36.2)	20 (39.2)		80 (32.3)	94 (38.1)
Meat, egg, and milk			0.679			0.510
Occasional	2 (4.3)	4 (7.8)		19 (7.7)	23 (9.3)
Frequent	45 (95.7)	47 (92.2)		229 (92.3)	224 (90.7)
Fruits and vegetables			0.496			0.724
Occasional	0 (0.0)	2 (3.9)		5 (2.0)	3 (1.2)
Frequent	47 (100.0)	49 (96.1)		243 (98.0)	244 (98.8)

¹Smoking or drinking now or having been smoking or drinking for more than 1 year.

²Long term use of drugs refers to using for more than 1 year.

H. pylori: Helicobacter pylori; EGC: Early gastric cancer; CCI: Charlson comorbidity index; PPI: Proton pump inhibitors; BMI: Body mass index; GC: Gastric cancer.

Full Size Table

Table 4 Multivariate logistic regression analysis of the risk factors of Helicobacter pylori eradication early gastric cancer, Helicobacter pylori-naive early gastric cancer, and Helicobacter pylori infection early gastric cancer

	H. pylori eradication EGC			H. pylori-naive EGC			H. pylori infection EGC
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
Age, years	1.20	1.05-1.37	0.008	1.13	1.06-1.19	< 0.001	1.12	1.02-1.22	0.014
Smoking	15.84	0.75-334.67	0.076	5.70	1.42-22.96	0.014	8.29	0.34-201.66	0.194
Yes vs no
Drinking	2.82	0.17-47.58	0.473	3.98	1.02-15.59	0.047	12.9	1.42-117.8	0.023
Yes vs no
Digestive comorbidities	3.57	0.35-36.60	0.284	5.32	1.57-18.03	0.003	6.63	1.02-43.34	0.048
Yes vs no
Smoked food	8.78	0.29-267.44	0.213	9.97	1.54-64.67	0.016
Frequent vs occasional
Hot food	11.28	0.70-182.98	0.088	3.59	1.07-12.11	0.039
Frequent vs occasional
Onion and garlic				5.26	1.21-22.88	0.027	3.67	0.54-25.08	0.186
Frequent vs occasional
Legumes	0.08	0.01-0.72	0.028	0.17	0.06-0.51	0.002	0.14	0.02-0.96	0.045
Frequent vs occasional
Nuts	0.04	0.01-0.55	0.017	0.24	0.08-0.77	0.015	0.11	0.02-0.86	0.035
Frequent vs occasional

H. pylori: Helicobacter pylori; EGC: Early gastric cancer; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Citation: Liu XY, Wang YQ, Li P, Zhang ST, Sun XJ. Development and validation of a nomogram incorporating dietary factors for predicting Helicobacter pylori-negative early gastric cancer risk. World J Gastroenterol 2025; 31(46): 112791
URL: https://www.wjgnet.com/1007-9327/full/v31/i46/112791.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i46.112791