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Background Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI) — the weight in kilograms divided by the square of the height in meters — and symptoms of gastroesophageal reflux disease in persons of normal weight has not been demonstrated.
Methods In 2000, we used a supplemental questionnaire to determine the frequency, severity, and duration of symptoms of gastroesophageal reflux disease among randomly selected participants in the Nurses' Health Study. After categorizing women according to BMI as measured in 1998, we used logistic-regression models to study the association between BMI and symptoms of gastroesophageal reflux disease.
Results Of 10,545 women who completed the questionnaire (response rate, 86 percent), 2310 (22 percent) reported having symptoms at least once a week, and 3419 (55 percent of those who had any symptoms) described their symptoms as moderate in severity. We observed a dose-dependent relationship between increasing BMI and frequent reflux symptoms (multivariate P for trend <0.001). As compared with women who had a BMI of 20.0 to 22.4, the multivariate odds ratios for frequent symptoms were 0.67 (95 percent confidence interval, 0.48 to 0.93) for a BMI of less than 20.0, 1.38 (95 percent confidence interval, 1.13 to 1.67) for a BMI of 22.5 to 24.9, 2.20 (95 percent confidence interval, 1.81 to 2.66) for a BMI of 25.0 to 27.4, 2.43 (95 percent confidence interval, 1.96 to 3.01) for a BMI of 27.5 to 29.9, 2.92 (95 percent confidence interval, 2.35 to 3.62) for a BMI of 30.0 to 34.9, and 2.93 (95 percent confidence interval, 2.24 to 3.85) for a BMI of 35.0 or more. Even in women with a normal baseline BMI, an increase in BMI of more than 3.5, as compared with no weight changes, was associated with an increased risk of frequent symptoms of reflux (odds ratio, 2.80; 95 percent confidence interval, 1.63 to 4.82).
Conclusions BMI is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women. Even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux.
Source Information
From Boston University School of Medicine and Boston Medical Center (B.C.J.), Beth Israel Deaconess Medical Center (S.C.S., C.P.K.), Dana–Farber Cancer Institute (C.S.F.), Massachusetts General Hospital (C.A.C.), and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (C.S.F., C.A.C.) — all in Boston.
Address reprint requests to Dr. Jacobson at Boston University Medical Center, 85 E. Concord St., Rm. 7721, Boston, MA 02118, or at brian.jacobson{at}bmc.org.
Related Letters:
BMI and Gastroesophageal Reflux in Women
Kostikas K., Papaioannou A. I., Gourgoulianis K. I., Etzel C. J., Kachroo S., Yanai H., Yoshida H., Tada N., Jacobson B. C., Camargo C. A. Jr.
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N Engl J Med 2006;
355:848-850, Aug 24, 2006.
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