A lifestyle-derived risk score for chronic atrophic gastritis: development and validation in 21,008 Chinese adults

Background: Chronic atrophic gastritis (AG) is a key precancerous lesion of gastric cancer. Modifiable lifestyle factors such as smoking, alcohol consumption, and specific dietary patterns are associated with the risk of AG. However, lifestyle indicators have not been integrated into clinical practice, and there is a lack of practical integrated risk assessment tools for primary healthcare settings. Objective: Develop and validate a simple lifestyle risk score to identify individuals at high risk of AG in the Chinese screening population. Methods: This population-based case-control study utilized data from the Upper Gastrointestinal Cancer Screening Program in Gansu Province, China. A total of 21,008 participants aged 40-70 years were included. AG status was determined based on endoscopic and pathological diagnoses. A risk score (range 0-7) was developed incorporating seven modifiable lifestyle factors, with fried food and garlic intake included as exploratory components based on prior literature. Associations were assessed using multivariate logistic regression, and predictive performance was evaluated through ROC curve analysis, calibration, and decision curve analysis. Results: for trend