Assessing the impact that patterns of Na intake may have on gastric cancer will provide a more comprehensive estimation of Na reduction as a primary prevention approach. We aimed to estimate the proportion of gastric cancer cases that are attributable to Na intake above the recommendation by the WHO (≤2 g/d) throughout the world in 2010, as well as expected values for 2030. Population attributable fractions (PAF) were computed for 187 countries, using Na intakes in 1990 and 2010 and estimates of the association between Na intake and gastric cancer, assuming a time lag of 20 years. Median PAF ranged from 10·1% in low to 22·5 % in very high Human Development Index (HDI) countries in men (P<0·001) and from 7·2 to 16·6 %, respectively, among women (P<0·001). An increase in median PAF until 2030 is expected in most settings, except for countries classified as low HDI, in both sexes. High Na intakes account for a large proportion of gastric cancer cases, and proportions are expected to increase in almost all of the countries. Intensified efforts to diminish Na intake in virtually all populations are needed to further reduce gastric cancer burden.

The regional and temporal variation in patterns of fruit and vegetable intake contributes to differences in the impact on gastric cancer burden across regions and over the years. We aimed to estimate the proportion and absolute number of gastric cancer cases that could have been prevented in 2012 with an increase in fruit and vegetable intake up to the levels defined by the Global Burden of Disease as the theoretical minimum-risk exposure distribution (300 and 400 g/d, respectively), as well as the corresponding figures expected for 2025. Preventable fractions (PF) were computed for 161 countries, using data on fruit and vegetable availability in 1997 and 2010 and published estimates of the magnitude of the association between fruit and vegetable intake and gastric cancer, assuming a time lag of approximately 15 years. Countries classified as very high Human Development Index (HDI) presented median PF in 2012 much lower than low-HDI countries for both fruits (3·0 v. 10·2 %, P<0·001) and vegetables (6·0 v. 11·9 %, P<0·001). For vegetables only, PF significantly decreased until 2025 in most settings; however, this corresponded to a reduction in the absolute number of preventable gastric cancer cases in less than half of the countries. Increasing fruit and vegetable intake would allow preventing a relatively high proportion of gastric cancer cases, mostly in developing countries. Although declines in PF are predicted in the near future, changes in order to achieve healthier lifestyles may be insufficient to overcome the load of demographic variation to further reduce the gastric cancer burden.

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.

Metastatic carcinoma of the tonsil is rare with only some 100 cases having been reported in the literature, of which nine have resulted from stomach carcinoma. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe here the clinical and histopathological findings of a case of unilateral palatine tonsil metastasis as the first sign of a signet-ring cell carcinoma of the stomach. This has not been reported previously.