Diet Curbs GERD Beyond Acid Suppressants- JAMA Study
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Adherence to an anti-reflux lifestyle may prevent many symptoms of gastrointestinal reflux disorder (GERD) in women, data from Nurses' Health Study II suggest. And the decreased risk was evident even in regular users of acid suppressants such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs).

"Possible explanations include decreases in lower esophageal sphincter tone, increases in gastroesophageal pressure gradients, and mechanical factors, including hiatal hernia," wrote researchers. In addition, they said in a research letter in JAMA Internal Medicine, the results support the importance of lifestyle modification in managing GERD.

The team explained that the overall Nurses' Health Study II is an ongoing nationwide prospective cohort study established in 1989 with 116,671 female participants who returned biennial health questionnaires with information on smoking, body mass index (BMI), physical activity, medication use, and history of diabetes, along with a "validated, semiquantitative" food frequency questionnaire every 4 years.

The cohort for the new analysis included 42,955 women ages 42 to 62. Over a period stretching from the return of the initial questionnaire in 2007 to a final follow-up in 2017, representing 392,215 person-years of follow-up, a total of 9,291 incident cases of GERD symptoms were identified.

The investigators used an anti-reflux lifestyle score (range 0-5) consisting of five variables:

- Normal weight, defined as BMI of 18.5 to less than 25.0
- Never smoking
- Moderate-to-vigorous physical activity for at least 30 minutes a day
- No more than two cups of coffee, tea, or soda daily
- Eating a prudent diet

Participants were considered to have GERD symptoms if they reported acid reflux or heartburn at least weekly, as in previous research by the same team. The estimated proportion of cases of GERD symptoms preventable by all five factors in the anti-reflux lifestyle score was 37%.

Compared with women who did not adhere to anti-reflux lifestyle factors, the multivariable hazard ratio (HR) for GERD symptoms was 0.50 in those with five anti-reflux lifestyle factors, the investigators reported.

Furthermore, each lifestyle factor was independently associated with GERD symptoms. The individual mutually adjusted multivariable HRs for non-adherence to each factor ranged from 0.94 for smoking to 0.69 for BMI.

"The diet associated with less reflux symptoms is generally in keeping with what we consider to be a healthy diet -- that is, low in concentrated sweets, red meat, and refined grains," researchers told. "This should be a fairly straightforward diet for people to follow, especially in view of the other potential health benefits."

They noted that the study focused on coffee, tea, and soda: "We did not examine specifically carbonated mineral water, but we think that coffee, tea, and soda may increase the risk of GERD because of their effect on the tone of the lower esophageal sphincter or the acidity of stomach contents," researchers explained. The group had previously reported that these three drinks were associated with a heightened risk of GERD symptoms.

The authors noted that they also considered the possibility that PPI and/or H2RA initiation during follow-up might have influenced the results. In analyses of the use of these agents to indicate the presence of GERD symptoms, participants with the five favorable lifestyle factors had a multivariable-adjusted HR of 0.47 for GERD manifestations compared with those with no anti-reflux lifestyle factors.

In an analysis of 3,625 women who reported regular use of PPIs and/or H2RAs and were free of GERD symptoms at baseline, those with the five factors had a multivariable-adjusted HR of 0.32 for GERD symptoms compared with PPI and/or H2RA users with none of the anti-reflux lifestyle factors.