Effects of Individual Components of Metabolic Syndrome on GERD Prevalence in a National Study of 125,029 Patients: Diabetes, but Not Hypertension or Hyperlipidemia, Significantly Increases the Risk of GERD Independent of Obesity

Abstract

Introduction: To identify epidemiologic factors associated with GERD, especially the components of the metabolic syndrome independent of obesity, including hypertension, hyperlipidemia and diabetes, after adjusting for obesity, a known risk factor for GERD. Methods: Analysis of limited access dataset of National Hospital Ambulatory Medical Care Survey (2006-2010). All patients with GERD were identified by ICD-9 diagnostic codes. Multiple factors were analyzed by multivariate logistic regression as independent risk factors for GERD, including age, socioeconomic status, smoking, urban status, and obesity (BMI >30). Also, individual components of metabolic syndrome were analyzed as independent risk factors for GERD after adjusting for obesity. Results: Among 125,029 analyzed patient visits, 1,860 patients had GERD. Patients >40 years old had significantly higher prevalence of GERD than patients <40 (OR 1.73 95% CI 1.56 to 1.92). Lower and lower middle class patients had significantly higher prevalence of GERD than upper class patients [(OR=1.47 CI: 1.29-1.67) and (OR=.16 CI: 1.01-1.32)], respectively]. Smokers and obese patients had significantly higher prevalence of GERD than non-smokers (OR=1.20 CI:1.04-1.40) and non-obese patients (OR=1.65 CI:1.47-1.88), respectively. Urban status did not influence prevalence of GERD (OR=0.88 CI: 0.77-1.02). Patients with metabolic syndrome had higher prevalence of GERD than obese patients (OR=1.34 CI: 1.08-1.78). However, among components of metabolic syndrome, only diabetes, but not hypertension or hyperlipidemia, significantly increased the risk of GERD in obese patients. Despite the importance of obesity in GERD, weight reduction and exercise counseling has lagged in obese patients with GERD compared to the general population (p=0.03 and p=<0.01). Conclusion: Older age, lower or lower middle income status, obesity, and smoking were associated with higher rates of GERD. Metabolic syndrome was identified as an independent risk factor for GERD after adjusting for obesity, but this increase was due to diabetes but not hypertension or hyperlipidemia. This study suggests that certain components of metabolic syndrome may contribute much more significantly to GERD than other components. These novel findings may have implications for the pathophysiology and treatment of GERD. These findings may identity patients at increased risk for GERD.