Low prevalence of gastroesophageal reflux symptoms in vegetarians
Tóm tắt
Dietary modification could reduce the risk of gastroesophageal reflux disease. Circumstantial evidence suggests that gastroesophageal reflux is less prevalent in people adhering to a vegetarian diet. We aimed to study the relationship between vegetarianism and the occurrence of gastroesophageal reflux symptoms (GERS). This study compares the prevalence of GERS in vegetarians with non-vegetarian controls from the general population. Frequency and severity of GERS (heartburn and/or acid regurgitation) were assessed with a self-administrated questionnaire. Within 1 year, any GERS were experienced by 19 of 100 (19%) vegetarians and by 98 of 250 (39.2%) non-vegetarian controls (p < 0.001). Frequent GERS, defined as GERS on at least 1 day per week, were noted in 3% of vegetarians and in 12.8% of controls (p = 0.006). Reflux symptoms were significantly less severe in vegetarians than in non-vegetarians (p < 0.001). According to multivariable analysis, independent predictors of GERS included male sex, current smoking, BMI ≥ 25 (odds ratio [OR] = 1.94; 95% confidence interval [CI], 1.14–3.31), and a non-vegetarian diet (OR = 2.19; 95% CI, 1.20–3.97); non-vegetarian diet independently predicted frequent GERS (OR 4.03; 95% CI, 1.17–13.9). An increased risk of GERS (OR = 2.17; 95% CI, 1.09–4.29) and frequent GERS (OR 4.00; 95% CI, 1.13–14.18) in non-vegetarians were also demonstrated by logistic regression of matched data. In non-vegetarians, the risk of reflux symptoms was not significantly related to meat intake. The prevalence and severity of GERS are lower in vegetarians than in non-vegetarians from the general population. The results are in line with a mitigating effect of vegetarianism on GERS. Data must be interpreted with caution given the retrospective study design and the small sample size.
Tài liệu tham khảo
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943.
Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut. 2012;61:1390–7.
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80.
Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.
Murao T, Sakurai K, Mihara S, Marubayashi T, Murakami Y, Sasaki Y. Lifestyle change influences on GERD in Japan: a study of participants in a health examination program. Dig Dis Sci. 2011;56:2857–64.
Festi D, Scaioli E, Baldi F, et al. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol. 2009;15:1690–701.
Sethi S, Richter JE. Diet and gastroesophageal reflux disease: role in pathogenesis and management. Curr Opin Gastroenterol. 2017;33:107–11.
Seremet N, Karaagaoglu N, Kaner G, Tel K. Gastroesophageal reflux symptoms and nutritional preferences. Studies on Ethno-Medicine. 2015;9:305–18.
Mone I, Kraja B, Bregu A, et al. Adherence to a predominantly Mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a South Eastern European population. Dis Esophagus. 2016;29:794–800.
Bhatia SJ, Reddy DN, Ghoshal UC, et al. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011;30:118–27.
Jung JG, Kang HW, Hahn SJ, et al. Vegetarianism as a protective factor for reflux esophagitis: a retrospective, cross-sectional study between Buddhist priests and general population. Dig Dis Sci. 2013;58:2244–52.
Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA. 2003;290:66–72.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.
Wiklund I, Carlsson J, Vakil N. Gastroesophageal reflux symptoms and well-being in a random sample of the general population of a Swedish community. Am J Gastroenterol. 2006;101:18–28.
Myrvold HE, Lundell L, Miettinen P, et al. The cost of long term therapy for gastro-oesophageal reflux disease: a randomised trial comparing omeprazole and open antireflux surgery. Gut. 2001;49:488–94.
Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016;14:175–82.
Esmaillzadeh A, Keshteli AH, Feizi A, Zaribaf F, Feinle-Bisset C, Adibi P. Patterns of diet-related practices and prevalence of gastro-esophageal reflux disease. Neurogastroenterol Motil. 2013;25:831-e638.
Yamamichi N, Mochizuki S, Asada-Hirayama I, et al. Lifestyle factors affecting gastroesophageal reflux disease symptoms: a cross-sectional study of healthy 19864 adults using FSSG scores. BMC Med. 2012;10:45.
O'Doherty MG, Cantwell MM, Murray LJ, Anderson LA, Abnet CC; FINBAR Study Group. Dietary fat and meat intakes and risk of reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma. Int J Cancer. 2011;129:1493–502.
Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Gastroenterology. 2007;132:87–95.
Niu CY, Zhou YL, Yan R, et al. Incidence of gastroesophageal reflux disease in Uygur and Han Chinese adults in Urumqi. World J Gastroenterol. 2012;18:7333–40.
El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54:11–7.
Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.
Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut. 2004;53:1730–5.
Nocon M, Labenz J, Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux - a population-based study. Aliment Pharmacol Ther. 2006;23:169–74.
DiSilvestro RA, Verbruggen MA, Offutt EJ. Anti-heartburn effects of a fenugreek fiber product. Phytother Res. 2011;25:88–91.
Rauma AL, Mykkanen H. Antioxidant status in vegetarians versus omnivores. Nutrition. 2000;16:111–9.
Olyaee M, Sontag S, Salman W, et al. Mucosal reactive oxygen species production in oesophagitis and Barrett’s oesophagus. Gut. 1995;37:168–73.
Oh TY, Lee JS, Ahn BO, et al. Oxidative stress is more important than acid in the pathogenesis of reflux oesophagitis in rats. Gut. 2001;49:364–71.
Veugelers PJ, Porter GA, Guernsey DL, Casson AG. Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Dis Esophagus. 2006;19:321–8.
McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low meat diets and health: a review. Public Health Nutr. 2012;15:1–8.
Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014;100 Suppl 1:353S–8S.
Beezhold BL, Johnston CS, Daigle DR. Vegetarian diets are associated with healthy mood states: a cross-sectional study in seventh day Adventist adults. Nutr J. 2010;9:26.
Beezhold B, Radnitz C, Rinne A, DiMatteo J. Vegans report less stress and anxiety than omnivores. Nutr Neurosci. 2015;18:289–96.
Okuyama M, Takaishi O, Nakahara K, et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scand J Gastroenterol. 2017;52:44–9.
Veggie-Report. Marktagent.com. A-2500 Baden. August 2017. http://www.marketagent.com/webfiles/MarketagentCustomer/pdf/015b2445-19d8-4d70-a812-97ab5d6755d8.pdf. Accessed 12 Jan 2019.
Unterhuber P Ernährung in Österreich. GfK Austria, Juli 2016. https://www.gfk.com/fileadmin/user_upload/dyna_content/AT/PM_2016/GfK_Charts_Ernaehrung.pdf. Accessed 12 Jan 2019.