WORD COUNT 3,535 words STUDY HIGHLIGHTS WHAT IS CURRENT KNOWLEDGE• Gastroesophageal reflux symptoms (GERS) can severely affect health related quality of life.• GERS are highly prevalent and the prevalence is still increasing.• High body mass index (BMI) is associated with prevalent GERS. WHAT IS NEW HERE• Gain in BMI was associated with new-onset GERS, independent of BMI at baseline.Higher gain in BMI was associated with increasing risk of new-onset GERS.• Ever having smoked tobacco was associated with new-onset GERS.• Tobacco smoking cessation was associated with new-onset GERS among those who gained weight upon quitting.• Increasing age and lower education was associated with new-onset GERS. ABSTRACT (Word count 249) OBJECTIVES:Gastroesophageal reflux disease (GERD) is a highly prevalent disorder. This study assessed risk factors of new-onset gastroesophageal reflux symptoms (GERS). METHODS:The study was based on the HUNT study, a prospective population-based cohort study conducted in 1995-1997 and 2006-2009 in Nord-Trøndelag County, Norway. All inhabitants from 20 years of age were invited. Risk factors of new-onset heartburn or acid regurgitation were examined using logistic regression, providing odds ratios (OR) and 95% confidence intervals (CI). RESULTS:29,610 individuals were included (61% response rate). Participants reporting no GERS at baseline and severe GERS at follow-up (new-onset GERS; n=510) were compared to participants reporting no complaints at both times (n=14,406). Increasing age (OR 1.01 per year, 95%CI 1.00-1.02) was positively whereas male sex (OR 0.81, 95% CI 0.66-0.98) and higher education (OR 0.69, 95%CI 0.56-0.86) were negatively associated with new-onset GERS. Gain in body mass index (BMI) was dose-dependently associated with new-onset GERS (OR 1.30 per unit increase in BMI, 95%CI 1.25-1.35), irrespective of baseline BMI. Previous and current tobacco smoking were associated with new-onset GERS (OR 1.37, 95%CI 1.07-1.76 and OR 1.29, 95%CI 1.00-1.67, respectively). Tobacco smoking cessation was associated with new-onset GERS among those with gain in BMI upon quitting (OR 2.03, 95% CI 1.31-3.16, with >3.5 BMI units increase). CONCLUSIONS:New-onset GERS were associated with increasing age, female sex, lower education, gain in BMI and ever tobacco smoking. Tobacco smoking cessation was associated with new-onset GERS among those who gained weight upon quitting.

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