Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review

Abstract

We performed this review to clarify which dietary and lifestyle factors are related to gastroesophageal reflux disease. Through a systematic search of the PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical Literature (CBM) databases, we identified articles with clear definitions of GERD, including nonerosive gastroesophageal reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE), that included dietary and lifestyle factors as independent factors affecting the onset of GERD (expressed as odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs)). Due to heterogeneity among the studies, we used descriptive statistical analyses to analyze and synthesize each outcome based on the disease type. In total, 72 articles were included, conducted in ten Western countries (26 articles in total) and nine Eastern countries (46 articles in total). We categorized dietary factors into 20 items and lifestyle factors into 11 items. GERD is related to many irregular dietary and lifestyle habits (such as a habit of midnight snacking: OR=5.08, 95% CI 4.03–6.4; skipping breakfast: OR=2.7, 95% CI 2.17–3.35; eating quickly: OR=4.06, 95% CI 3.11–5.29; eating very hot foods: OR=1.81, 95% CI 1.37–2.4; and eating beyond fullness: OR=2.85, 95% CI 2.18–3.73). Vegetarian diets (consumption of nonvegetarian food (no/yes); OR=0.34, 95% CI 0.211–0.545) and no intake of meat (OR=0.841, 95% CI 0.715–0.990) were negatively related to GERD, while meat (daily meat, fish, and egg intake: OR=1.088, 95% CI 1.042-1.135) and fat (high–fat diet: OR=7.568, 95% CI 4.557–8.908) consumption were positively related to GERD. An interval of less than three hours between dinner and bedtime (OR=7.45, 95% CI 3.38–16.4) was positively related to GERD, and proper physical exercise (physical exercise >30 minutes (>3 times/week): OR=0.7, 95% CI 0.6–0.9) was negatively correlated with GERD. Smoking (OR=1.19, 95% CI 1.12–1.264), alcohol consumption (OR=1.278, 95% CI 1.207–1.353) and mental state (poor mental state: OR=1.278, 95% CI 1.207–1.353) were positively correlated with GERD. RE (vitamin C: OR=0.46, 95% CI=0.24–0.90) and BE (vitamin C: OR=0.44,95% CI 0.2-0.98; vitamin E: OR=0.46, 95% CI 0.26–0.83) were generally negatively correlated with antioxidant intake. In conclusion, many dietary and lifestyle factors affect the onset of GERD, and these factors differ among regions and disease types. These findings need to be further confirmed in subsequent studies.

Role of Obesity, Physical Exercise, Adipose Tissue-Skeletal Muscle Crosstalk and Molecular Advances in Barrett’s Esophagus and Esophageal Adenocarcinoma

“…It is of interest that these effects were recorded independently of BMI. Dietary habits such as irregular food consumption, especially in the evening hours, and a diet rich in reflux-promoting factors may also worsen GERD symptoms in obese subjects [ 122 , 123 , 124 , 125 , 126 , 127 , 128 ].…”

Prevalence of Gastroesophageal Disease and Associated Risk Factors Among the Population in Al-Qunfudah

“…Spicy food, eating citrus fruits with meals, fried foods, greasy foods, eating snacks at night, frequently skipping breakfast, eating quickly, eating hot food, and overeating are all positively correlated with GERD. In contrast, vegetarian diets, fruits, vegetables, vitamins, fiber, and proper physical exercise were negatively correlated with GERD [ 26 ]. Among the participants in our study, fatty, fried, and spicy foods were the major dietary factors that aggravated the symptoms of GERD: 49.4% reported symptom aggravation by consuming fatty and fried food, 46.7% by consuming spicy food, and 27.3% by eating tomato products such as tomato sauce and ketchup.…”

“…Many studies have reported that alcohol consumption is a risk factor for GERD [ 2 , 17 , 26 ]. In our study, we could not evaluate this aspect as alcohol consumption is prohibited in Saudi Arabia.…”

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

“…42 The strongest risk was associated with "less than 3-hour interval between dinner and bed" (OR 7.45, 95% CI 16.4) and "high-fat diet" (OR 7.568, 95% CI 4.557-8.908), whereas vegetarian diet had the strongest negative relationship (OR 0.34, 95% CI 0.211-0.545). 42 Also, a recent study found that a simple strategy helping GORD patients identify and eliminate dietary triggers significantly reduced symptoms and the need for pharmacological treatment. 43 Lifestyle advice is relevant for all patients, even those on antisecretory therapy.…”

“…Nonetheless, simple dietary and lifestyle advice may suffice for patients with reflux‐like symptoms. A recent meta‐analysis found a clear relationship between reflux‐like symptoms and irregular eating habits, including late‐night snacking, skipping breakfast, eating quickly or eating beyond fullness 42 . The strongest risk was associated with “less than 3‐hour interval between dinner and bed” (OR 7.45, 95% CI 3.38–16.4) and “high‐fat diet” (OR 7.568, 95% CI 4.557–8.908), whereas vegetarian diet had the strongest negative relationship (OR 0.34, 95% CI 0.211–0.545) 42 .…”