Is gastroesophageal reflux disease in south Indian population influenced by waist hip ratio and body mass index?

Abstract

Dear Editor: It is widely believed that obesity, especially truncal, increases the risk of gastroesophageal reflux disease (GERD) particularly in the western population [1, 2]. A high body mass index (BMI) [>25.0 kg/m] has been associated with increased risk of erosive esophagitis, Barrett’s esophagus (BE), and adenocarcinoma [3]. Recent studies in the West have shown the waist to hip ratio (WHR), but not BMI, as the key factor associated with GERD complications [3]. We therefore intended to study whether typical and atypical GERD symptoms were associated with BMI and WHR abnormalities. We did a hospital-based case control study, recruiting consecutive cases attending the Department of Gastroenterology at Government Stanley Medical College Hospital, Chennai (tertiary care center catering to lower socioeconomic population) in 2009–2010, with typical GERD symptoms defined as heartburn, regurgitation, or combination of both and atypical GERD symptoms (noncardiac chest pain, chronic cough, unexplained otalgia, dysphonia). Minimum criterion for selectionwas presence of GERD symptoms at least once a week for 6 months. No symptom-based scoring systemwas used during the study. Controls were unmatched patients attending the same outpatient clinic with lower gastrointestinal (GI) symptoms or nonspecific abdominal pain with no upper GI or alarm symptoms like anorexia or weight loss. Patients with gastric outlet obstruction or previous gastric surgery causing secondary esophagitis were excluded. Baseline demographic details, weight, height, and waist and hip circumferences were obtained for all cases and controls. BMI and WHR were calculated from these. A BMI >23, WHR >0.90 (men), and >0.85 (women) were considered abnormal [4]. Analysis was done by gender, comparing cases and controls for demographic characteristics. Before analyzing the individual effect of BMI and WHR on GERD, the presence of any correlation between these two parameters was assessed in both men and women. Ethics committee of the institution (Stanley Medical College Hospital) approved the study. SPSS Version 20 was used for analysis: chi-square test for proportions, Wilcoxon sign rank sum test for comparison of median, and ANOVA for comparison of means. Odds ratio (OR) was computed only for significant risk factors with p<0.05. There were 107 men (+71 controls) and 152 women (+ 93 controls) with GERD symptoms. The median age among men and women in both cases and controls were similar (40 years). There were significantly more smokers (p<0.005), alcoholics (p<0.05), and tobacco chewers (p<0.00001) among men with GERD. As BMI and WHR were not associated with each other in both genders (male r 0.049; female r 0.16), their effect on GERD symptoms was analyzed separately. The prevalence of typical and atypical GERD symptoms was similar in men and women (p not significant). In women, (Table 1) GERD symptoms were not influenced by a raised BMI (OR 1.3; 95 % confidence interval (CI) 1.0–1.6; p<0.05) and in fact, WHR was negatively associated with GERD (OR 0.8; 95 % CI 0.7–1.0; p<0.05). Likewise, individual typical and atypical GERD symptoms were not influenced by raised BMI or WHR. Similarly, in men, GERD symptoms * V. Jayanthi drjayanthi35@yahoo.co.in