Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer: synergistic risk factors and precision screening strategies for <italic style="font-style: italic">Helicobacter pylori</italic> infection among adults in Huaihe River Basin

YAN Ruohan; WU Xiaomin; WANG Baohua; YU Miao; WU Jing

doi:10.16016/j.2097-0927.202603005

您当前的位置：

首页 >

文章列表页 >

Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer: synergistic risk factors and precision screening strategies for Helicobacter pylori infection among adults in Huaihe River Basin

Think Tank for Public Health | 更新时间：2026-07-15

- Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer: synergistic risk factors and precision screening strategies for Helicobacter pylori infection among adults in Huaihe River Basin
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1886-1896(2026)
- 作者机构：
  
  1.天津医科大学公共卫生学院，天津
  2.中国疾病预防控制中心慢性非传染性疾病控制中心，北京
  3.内蒙古医科大学公共卫生学院，内蒙古呼和浩特
- 作者简介：
  
  WU Jingvwujing@chinacdc.cn
- 基金信息：
  
  the Major National Science and Technology Program(2023ZD0509800;2023ZD0509801)
- DOI：10.16016/j.2097-0927.202603005
  CLC： R151.42;R377;R573
- Received：02 March 2026，
  
  Revised：2026-05-04，
  
  Accepted：12 May 2026，
  
  Published：15 July 2026
- 稿件说明：
移动端阅览
严若菡，吴晓敏，王宝华，等.饮酒+高盐饮食、饮酒+胃癌家族史：淮河流域成人幽门螺杆菌感染风险叠加因素与精准筛查策略［J］.陆军军医大学学报，2026，48（13）：1886-1896.DOI：10.16016/j.2097-0927.202603005.

YAN R H，WU X M，WANG B H，et al.Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer： synergistic risk factors and precision screening strategies for Helicobacter pylori infection among adults in Huaihe River Basin［J］.J Army Med Univ，2026，48（13）：1886-1896.DOI：10.16016/j.2097-0927.202603005.
严若菡，吴晓敏，王宝华，等.饮酒+高盐饮食、饮酒+胃癌家族史：淮河流域成人幽门螺杆菌感染风险叠加因素与精准筛查策略［J］.陆军军医大学学报，2026，48（13）：1886-1896.DOI：10.16016/j.2097-0927.202603005. DOI：

YAN R H，WU X M，WANG B H，et al.Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer： synergistic risk factors and precision screening strategies for Helicobacter pylori infection among adults in Huaihe River Basin［J］.J Army Med Univ，2026，48（13）：1886-1896.DOI：10.16016/j.2097-0927.202603005. DOI：

摘要

目的

当前幽门螺杆菌（

Helicobacter pylori

， HP）防控策略多基于单一因素评估，饮酒、高盐饮食及胃癌家族史在HP感染中是否存在联合效应尚不明确。本研究旨在明确淮河流域成年人群HP感染现状，并重点分析上述3种危险因素两两之间是否存在增加感染风险的相加交互作用，以期为胃癌高发区制定精准分层防控策略提供科学依据。

方法

采用横断面研究设计，于江苏、安徽、山东、河南4省27个区县采用多阶段分层整群随机抽样方法，抽取当地常住成年居民作为研究对象。通过问卷调查收集人口学特征、生活方式及胃癌家族史等信息；采用

C尿素呼气试验进行HP检测；测量身高、体质量并计算体质指数（body mass index，BMI）。将研究对象按HP检测结果分为阳性组与阴性组，采用二分类Logistic回归模型（递进校正人口学、社会经济及生活方式混杂因素）评估各因素的独立关联，并进一步计算相乘交互项及相加交互作用

指标［交互作用相对超额风险（relative excess risk due to interaction，

RERI

）；交互作用归因比（attributable proportion due to interaction，

）；协同指数（synergy index，

）］以量化因素间的协同效应。

结果

共纳入7 629例研究对象，HP阳性率为29.6%（2 255例）。多因素Logistic回归分析显示，高盐饮食偏好（

=1.36，95%

：1.19~1.56，

0.001）和胃癌家族史（

=1.56，95%

：1.22~1.99，

0.001）与HP感染呈显著正向关联；饮酒与HP感染呈负向关联（

=0.77，95%

：0.67~0.88，

0.001）。交互分析发现饮酒与高盐饮食在相乘（

=1.03，95%

：

1.01~1.04，

0.001）及相加尺度（

=0.166，95%

：0.023~0.308）均呈正向交互，共存时

为2.012（95%

：1.680~2.630，

0.001），但相加交互指标

RERI

与

未达统计学显著；饮酒与胃癌家族史在相加尺度上（

=0.194，95%

：0.050~0.337）呈现正向交互，共存

增至2.521（95%

：1.615~3.934，

0.001），但相乘交互及相加指标

RERI

与

均未达显著；高盐饮食与胃癌家族史的相加交互指标（

AP=

0.207，95%

：0.063~0.350）同样提示正向趋势。

结论

淮河流域成年人HP感染率仍较高，高盐饮食与胃癌家族史为其危险因素（饮酒呈负相关但不宜预防），且生活方式与遗传背景对感染存在具公共卫生意义的潜在协同效应。对策　建议立足《健康中国行动——癌症防治行动实施方案（2023—2030年）》，在胃癌高发区构建“生活方式+家族史”联合暴露筛查机制，将“饮酒合并高盐饮食”及“有胃癌家族史的饮酒者”列为高危优先筛查人群；推行以家庭为单位的“同筛同治”，捆绑减盐环境改造与高危成员根除治疗；强化“限酒减盐”联合健康教育，纠正“饮酒防HP”认知误区，推动一级预防与二级预防有机衔接。

Abstract

Objective

Current

Helicobacter pylori

(HP) prevention and control strategies are mostly based on single-factor assessments

and whether alcohol consumption

high-salt diet

and family history of gastric cancer exhibit joint effects on HP infection remains unclear. This study aims to determine the current prevalence of HP infection among adults in the Huaihe River Basin

and to analyze whether pairwise additive

interactions exist among these three risk factors in increasing infection risk

thereby providing a scientific basis for formulating precision stratified prevention and control strategies in high-incidence areas of gastric cancer.

Methods

A cross-sectional study design was adopted. Local permanent adult residents were recruited from 27 districts/counties across 4 provinces (Jiangsu

Anhui

Shandong

and Henan)

via

a multi-stage stratified cluster random sampling. Demographic characteristics

lifestyle factors

and family history of gastric cancer were collected through questionnaire surveys. HP status was determined using the

C-urea breath test. Height and body weight were measured to calculate body mass index (BMI). Based on the results of HP test

the participants were divided into positive and negative groups. Binary logistic regression models

with progressive adjustment for demographic

socioeconomic

and lifestyle confounders

were employed to evaluate the independent associations of each factor. Multiplicative interaction terms and additive interaction measures [relative excess risk due to interaction (

RERI

)

attributable proportion due to interaction (

)

and synergy index (

)

]

were calculated to quantify the synergistic effects among these factors.

Results

A total of 7 629 participants were included in the study

with an overall HP positivity rate of 29.6% (

=2 255). Multivariate logistic regression analysis revealed that preference for high-salt diet (

=1.36

95%

: 1.19 to 1.56

0.001) and family history of gastric cancer (

=1.56

95%

: 1.22 to 1.99

0.001) were significantly positively associated with HP infection; alcohol consumption was negatively associated with HP infection (

=0.77

95%

0.67 to 0.88

0.001). Interaction analysis revealed a synergistic effect when alcohol consumption was combined with other risk factors. The combination of alcohol consumption and high-salt diet showed significant positive multiplicative (

=1.03

95%

: 1.01 to 1.04) and additive (

=0.166

95%

: 0.023 to 0.308) interactions

with a coexisting

of 2.012 (95%

: 1.680 to 2.630

0.001)

although the additive interaction indicators

RERI

and

did not reach statistical significance. Alcohol consumption and family history of gastric cancer showed a positive interaction (

=0.194

95%

: 0.050 to 0.337)

with the coexisting

increasing to 2.521 (95%

: 1.615 to 3.934

0.001)

but multiplicative interaction and additive indicators

RERI

and

did not reach significance. The co-exposure of high-salt diet and family history of gastric cancer also yielded a positive additive trend (

=0.207

95%

: 0.063 to 0.350).

Conclusion

The prevalence of HP infection among adults in the Huaihe River Basin remains relatively high. High-salt diet and family history of gastric cancer are risk factors for HP infection (Alcohol consumption shows a negative association but should not be used for prevention)

and lifestyle and genetic background exhibit potential synergistic effects on the infection with public health significance. Countermeasures　Based on the “Healthy China Initiative—Cancer Prevention and Control Action Plan (2023—2030)”

it is recommended to establish a combined exposure screening mechanism integrating “lifestyle plus family history” in gastric cancer high-risk areas

prioritizing “alcohol consumption combined with high-salt diet” and “drinkers with a family history of gastric cancer” as high-risk screening populations. Family-based “simultaneous screening and treatment” should be promoted

integrating salt-reduction environmental modification with eradication therapy for high-risk members. Joint health education on “alcohol limitation and salt reduction” should be strengthened to correct the misconception that “alcohol consumption prevents HP”

hereby promoting organic integration of primary and secondary prevention.

关键词

Keywords

references

BOUVARD V ， BAAN R ， STRAIF K ， et al . A review of human carcinogens： Part B： biological agents ［J］. Lancet Oncol ， 2009 ， 10 （ 4 ）： 321 - 322 . DOI： 10.1016/s1470-2045（09）70096-8 http://dx.doi.org/10.1016/s1470-2045（09）70096-8 .

LI Y H ， CHOI H ， LEUNG K ， et al . Global prevalence of Helicobacter pylori infection between 1980 and 2022： a systematic review and meta-analysis ［J］. Lancet Gastroenterol Hepatol ， 2023 ， 8 （ 6 ）： 553 - 564 . DOI： 10.1016/S2468-1253（23）00070-5 http://dx.doi.org/10.1016/S2468-1253（23）00070-5 .

XIE L ， LIU G W ， LIU Y N ， et al . Prevalence of Helicobacter pylori infection in China from 2014-2023： a systematic review and meta-analysis ［J］. World J Gastroenterol ， 2024 ， 30 （ 43 ）： 4636 - 4656 . DOI： 10.3748/wjg.v30.i43.4636 http://dx.doi.org/10.3748/wjg.v30.i43.4636 .

中华医学会消化病学分会幽门螺杆菌学组 . 第六次全国幽门螺杆菌感染处理共识报告（非根除治疗部分）［J］. 中华消化杂志， 2022 ， 42 （ 05 ）： 289 - 303 . DOI： 10.3760/cma.j.cn311367-20220206-00057 http://dx.doi.org/10.3760/cma.j.cn311367-20220206-00057 .

Helicobacter pylori Study Group of Chinese Society of Gastroenterology . Sixth Chinese national consensus report on management of Helicobacter pylori infection（treatment excluded）［J］. Chin J Dig ， 2022 ， 42 （ 05 ）： 289 - 303 . DOI： 10.3760/cma.j.cn311367-20220206-00057 http://dx.doi.org/10.3760/cma.j.cn311367-20220206-00057 .

WANG L ， LI Z K ， LAI J X ， et al . Risk factors associated with Helicobacter pylori infection in the urban population of China： a nationwide， multi-center， cross-sectional study ［J］. Int J Infect Dis ， 2025 ， 154 ： 107890 . DOI： 10.1016/j.ijid.2025.107890 http://dx.doi.org/10.1016/j.ijid.2025.107890 .

LEUNG W K ， NG E K W ， LAM C C H ， et al . Helicobacter pylori infection in 1st degree relatives of Chinese gastric cancer patients ［J］. Scand J Gastroenterol ， 2006 ， 41 （ 3 ）： 274 - 279 . DOI： 10.1080/00365520510024269 http://dx.doi.org/10.1080/00365520510024269 .

KIM S ， KIM M S ， KWON Y ， et al . Environmental protective and risk factors for gastric cancer： an umbrella review and reanalysis of meta-analyses ［J］. J Gastric Cancer ， 2025 ， 25 （ 2 ）： 285 . DOI： 10.5230/jgc.2025.25.e16 http://dx.doi.org/10.5230/jgc.2025.25.e16 .

JIANG L P ， LAU H C ， ZENG R J ， et al . Diet， gastric microbiota， and metabolites in gastric tumorigenesis ［J］. Research ， 2025 ， 8 ： 693 . DOI： 10.34133/research.0693 http://dx.doi.org/10.34133/research.0693 .

BALENDRA V ， AMOROSO C ， GALASSI B ， et al . High-salt diet exacerbates H. pylori infection and increases gastric cancer risks ［J］. J Pers Med ， 2023 ， 13 （ 9 ）： 1325 . DOI： 10.3390/jpm13091325 http://dx.doi.org/10.3390/jpm13091325 .

GADDY J A ， RADIN J N ， LOH J T ， et al . High dietary salt intake exacerbates Helicobacter pylori -induced gastric carcinogenesis ［J］. Infect Immun ， 2013 ， 81 （ 6 ）： 2258 - 2267 . DOI： 10.1128/iai.01271-12 http://dx.doi.org/10.1128/iai.01271-12 .

ROKKAS T ， SECHOPOULOS P ， PISTIOLAS D ， et al . Helicobacter pylori infection and gastric histology in first-degree relatives of gastric cancer patients： a meta-analysis ［J］. Eur J Gastroenterol Hepatol ， 2010 ， 22 （ 9 ）： 1128 - 1133 . DOI： 10.1097/meg.0b013e3283398d37 http://dx.doi.org/10.1097/meg.0b013e3283398d37 .

HUANG A F ， HE C ， SHENG J W ， et al . The epidemiological study of family-based Helicobacter pylori screening and its benefits： a cross-sectional study ［J］. Sci Rep ， 2025 ， 15 ： 5553 . DOI： 10.1038/s41598-025-87836-5 http://dx.doi.org/10.1038/s41598-025-87836-5 .

EL FILALY H ， OUTLIOUA A ， DESTERKE C ， et al . IL-1 polymorphism and Helicobacter pylori infection features： highlighting VNTR’s potential in predicting the susceptibility to infection-associated disease development ［J］. Microorganisms ， 2023 ， 11 （ 2 ）： 353 . DOI： 10.3390/microorganisms11020353 http://dx.doi.org/10.3390/microorganisms11020353 .

XU Z J ， SUN X ， DONG Q J ， et al . The association between toll-like receptor gene polymorphism and Helicobacter pylori infection risk： a systematic review and meta-analysis ［J］. Medicine ， 2026 ， 105 （ 8 ）： e47788 . DOI： 10.1097/md. 0000000000047788 http://dx.doi.org/10.1097/md.0000000000047788 .

YU Y H ， ZHENG Z H ， GAO X X ， et al . Plasma metabolomic signatures of H. pylori infection， alcohol drinking， smoking， and risk of gastric cancer ［J］. Mol Carcinog ， 2025 ， 64 （ 3 ）： 463 - 474 . DOI： 10.1002/mc.23851 http://dx.doi.org/10.1002/mc.23851 .

DING S Z ， DU Y Q ， LU H ， et al . Chinese consensus report on family-based Helicobacter pylori infection control and management （2021 edition）［J］. Gut ， 2022 ， 71 （ 2 ）： 238 - 253 . DOI： 10.1136/gutjnl-2021-325630 http://dx.doi.org/10.1136/gutjnl-2021-325630 .

DU P Q ， ZHANG C ， WANG A F ， et al . Association of alcohol drinking and Helicobacter pylori infection： a meta-analysis ［J］. J Clin Gastroenterol ， 2023 ， 57 （ 3 ）： 269 - 277 . DOI： 10.1097/MCG.0000000000001638 http://dx.doi.org/10.1097/MCG.0000000000001638 .

BRENNER H ， ROTHENBACHER D ， BODE G ， et al . Inverse graded relation between alcohol consumption and active infection with helicobacter pylori ［J］. Am J Epidemiol ， 1999 ， 149 （ 6 ）： 571 - 576 . DOI： 10.1093/oxfordjournals.aje.a009854 http://dx.doi.org/10.1093/oxfordjournals.aje.a009854 .

MURRAY L J ， LANE A J ， HARVEY I M ， et al . Inverse relationship between alcohol consumption and active Helicobacter pylori infection： the Bristol Helicobacter project ［J］. Am J Gastroenterol ， 2002 ， 97 （ 11 ）： 2750 - 2755 . DOI： 10.1016/S0002-9270（02）05481-3 http://dx.doi.org/10.1016/S0002-9270（02）05481-3 .

YU J ， LV Y M ， YANG P ， et al . Alcohol increases treatment failure for Helicobacter pylori eradication in Asian populations ［J］. BMC Gastroenterol ， 2023 ， 23 （ 1 ）： 365 . DOI： 10.1186/s12876-023-03002-z http://dx.doi.org/10.1186/s12876-023-03002-z .

YIE G E ， SHIN C M ， PARK K ， et al . Discrepancy between genetically predicted and observed alcohol intake and its impact on gastric cancer susceptibility ［J］. Cancer Res Treat ， 2026 ， 58 （ 2 ）： 563 - 572 . DOI： 10.4143/crt.2025.109 http://dx.doi.org/10.4143/crt.2025.109 .

HAVLIKOVA J ， DEJMEK M ， HUSKOVA A ， et al . Mechanistic insights into alcohol-induced DNA crosslink repair by Slx4-Xpf-Ercc1 nuclease complex in the Fanconi anaemia pathway ［J］. Commun Biol ， 2025 ， 8 ： 1374 . DOI： 10.1038/s42003-025-08769-3 http://dx.doi.org/10.1038/s42003-025-08769-3 .

ASONUMA S ， HATTA W ， KOIKE T ， et al . Risk stratification of synchronous gastric cancers including alcohol-related genetic polymorphisms ［J］. J Gastro And Hepatol ， 2024 ， 39 （ 8 ）： 1554 - 1562 . DOI： 10.1111/jgh. 16570 http://dx.doi.org/10.1111/jgh.16570 .

KWAK J H ， EUN C S ， HAN D S ， et al . Effects of RAD50 SNP， sodium intake， and H. pylori infection on gastric cancer survival in Korea ［J］. Gastric Cancer ， 2024 ， 27 （ 2 ）： 210 - 220 . DOI： 10.1007/s10120-023-01441-x http://dx.doi.org/10.1007/s10120-023-01441-x .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Lifestyle behaviors and serum biochemical indicators jointly influence heat tolerance in young adult males: a cross-sectional study in Hainan region

High-salt diet promotes the progression of fibrosis in metabolic dysfunction-associated steatohepatitis via activating the PI3K/Akt/mTOR signaling pathway

Risk factors for stroke-associated pneumonia after endovasular treatment in acute anterior circulation ischemic stroke patients

Impact of molecular heterogeneity of NPM1 mutations on prognosis of acute myeloid leukemia: a clinical report of 86 cases

Efficacy and prognostic factors of second transurethral resection for non-muscle-invasive bladder cancer

Related Author

Luo Zhen

He Genlin

Luo Xue

Li Ping

Hu Xiao

Yang Xuesen

Tan Yulong

TANG Yin

Related Institution

Department of Tropical Medicine， College of Military Preventive Medicine， Army Medical University （Third Military Medical University）

Department of Hepatobiliary Surgery， First Affiliated Hospital（Southwest Hospital）， Army Medical University （Third Military Medical University）

Department of Neurology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Chongqing Center for Disease Control and Prevention

the First Clinical Medical College of Lanzhou University, the First Hospital of Lanzhou University

⁰

Alcohol consumption plus high-salt diet and alcohol consumption plus family history of gastric cancer: synergistic risk factors and precision screening strategies for Helicobacter pylori infection among adults in Huaihe River Basin

DOI：10.16016/j.2097-0927.202603005

摘要

Abstract

关键词

Keywords

references