Obesity and Estrogen as Risk Factors for Gastroesophageal Reflux Symptoms

Abstract

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 been proposed. 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 65363 adult participants in the second survey, 3113 individuals who reported severe heartburn or regurgitation during the last 12 months were defined as cases, whereas 39872 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 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