指南问题9：减少饮酒是否能够降低胃癌发生风险？ 推荐意见9：建议减少饮酒或戒酒来降低胃癌的发生风险（弱推荐，证据级别：中）。 酒精可刺激胃肠道，导致恶心、呕吐、腹痛等症状，引起胃黏膜损伤与出血。同时，酒精对肝脏、神经系统和内分泌系统等也会造成一定的损伤。 酒精摄入与胃癌的发生密切相关。综合分析截至2021年全球相关81项研究数据的结果显示，相比不饮酒人群，饮酒人群（≥14 g酒精/d）的胃癌发生风险增加了20%，而酗酒人群（≥42 g酒精/d或140 g纯酒精/周）的胃癌发生风险增加了30%（表10）［29］。进一步分析显示胃癌风险明显随饮酒量增加而增加，且饮酒对胃癌风险的影响在中国人群中尤其明显［29］。 《中国居民膳食指南（2022）》建议成年人每天最大酒精摄入量不得超过15 g，相当于酒精度4%vol的啤酒450 ml、酒精度12%vol的葡萄酒150 ml、酒精度38%vol的白酒50 ml或酒精度52%vol的高度白酒30 ml［25］。因此，推荐减少酒精摄入或戒酒以降低胃癌的发生风险。全球疾病负担工作组2018 年发表的研究认为饮酒不存在安全阈值，不饮酒的总健康风险最低［30］。
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