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Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and Estrogen as Risk Factors for Gastroesophageal Reflux Symptoms. JAMA. 2003;290(1):66–72. doi:10.1001/jama.290.1.66
Author Affiliations: Department of Surgery, Karolinska Institutet, Karolinska Hospital (Drs Nilsson and Lagergren), and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (Drs Nilsson, Ye, and Lagergren), Stockholm, Sweden; Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway (Dr Johnsen); and Department of Medicine, Levanger Hospital, Levanger, Norway, and HUNT Research Centre, Verdal, Norway (Dr Hveem).
Context Gastroesophageal reflux and obesity are both increasing in prevalence.
The scientific evidence for an association between these conditions is sparse
and contradictory. A difference between sexes concerning this relation has
Objective To evaluate the relation between body mass and gastroesophageal reflux
symptoms and determine how this relation is influenced by female sex hormones.
Design Population-based, cross-sectional, case-control study.
Setting Two consecutive public health surveys within the county of Nord-Trondelag,
Norway, conducted in 1984-1986 and 1995-1997.
Participants Among 65 363 adult participants in the second survey, 3113 individuals
who reported severe heartburn or regurgitation during the last 12 months were
defined as cases, whereas 39 872 persons without reflux symptoms were
defined as controls.
Main Outcome Measure Risk of reflux, estimated using multivariate logistic regression, with
odds ratios (ORs) and 95% confidence intervals (CIs) as measures of association.
Results There was a dose-response association between increasing body mass index
(BMI) and reflux symptoms in both sexes (P for trend
<.001), with a significantly stronger association in women (P<.001). Compared with those with a BMI less than 25, the risk of
reflux was increased significantly among severely obese (BMI >35) men(OR,
3.3; 95% CI, 2.4-4.7) and women (OR, 6.3; 95% CI, 4.9-8.0). The association
between BMI and reflux symptoms was stronger among premenopausal women compared
with postmenopausal women (P<.001), although use
of postmenopausal hormone therapy increased the strength of the association
(P<.001). Reduction in BMI was associated with
decreased risk of reflux symptoms.
Conclusions There is a significant association between body mass and symptoms of
gastroesophageal reflux. The association is stronger among women, especially
premenopausally, and use of hormone therapy strengthens the association, suggesting
that estrogens may play an important role in the etiology of reflux disease.
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