Numerous epidemiologic associations have been made between (1) environmental and dietary factors and (2) the incidence of gastric cancer, including all except:

D. Dietary ascorbic acid.

DISCUSSION: Numerous epidemiologic studies support the role of certain foods in the development of gastric cancer. Salt, which can act as a gastric irritant, and nitrates and nitrites, which can be converted to the active carcinogens N-nitrosamines, are implicated in the development of gastric cancer. H. pylori infection is associated with atrophic gastritis, a known precursor to gastric cancer. Important studies of large populations indicate that the majority of patients with gastric cancer are H. pylori positive. The bacteria produce toxins such as ammonia and acetaldehyde, which could lead to chronic inflammation and epithelial damage. Dietary ascorbic acid has been associated with overall improvements in diet and is not associated with the development of gastric cancer.