Fox Mark, Barr Carole, Nolan Suzanne, Lomer Miranda, Anggiansah Angela, Wong Terry
Department of Gastroenterology, St Thomas' Hospital, London, United Kingdom.
Clin Gastroenterol Hepatol. 2007 Apr;5(4):439-44. doi: 10.1016/j.cgh.2006.12.013. Epub 2007 Mar 23.
BACKGROUND & AIMS: The effects of diet on gastroesophageal reflux disease are not well understood. This study assessed the effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms in patients with reflux symptoms.
Patients referred for the investigation of reflux symptoms were recruited (most with nonerosive disease). A catheter-free system provided esophageal pH monitoring over 4 days in 4 dietary conditions. A high-fat (50%) vs low-fat (25%) diet (calorie-controlled), and a high-calorie (1000 kcal) vs low-calorie (500 kcal) diet (fat-controlled) were provided in randomized order, and meal volume was controlled. The effects of meal consistency also were studied.
Complete data were available for 15 patients (6 men, 9 women; age, 48 y; range, 26-70 y; body mass index, 26 kg/m2; body mass index range, 21-35 kg/m2). Demographic variables and meal sequence had no effect on reflux parameters. Dietary composition had effects on esophageal acid exposure (F statistic [analysis of variance] = 7.4, P < .005) and symptoms (Friedman test = 24.2, P < .001). No effect of meal consistency was present. Esophageal acid exposure was greater during the high-calorie than the low-calorie diet (mean, 8.6% +/- 2.0% vs 5.2% +/- 1.4% time pH < 4/24 h; P < .01). No difference was observed between the high-fat and low-fat diets (mean, 8.6% +/- 2.0% vs 8.2% +/- 1.6% time pH < 4/24 h; P = NS). In contrast, the frequency of reflux symptoms was not affected by calorie density (median, 6; range, 2-12 vs median, 8; range, 2-13; P = NS) but was increased by the high-fat compared with the low-fat diet (median, 11; range, 5-18 vs median, 6; range, 2-12; P < .05).
Calorie density determines the severity of esophageal acid exposure in gastroesophageal reflux disease after a meal; however, the percentage fat content of the diet has important effects on the frequency of reflux symptoms.
饮食对胃食管反流病的影响尚未完全明确。本研究评估了膳食脂肪和热量密度对有反流症状患者食管酸暴露及反流症状的影响。
招募因反流症状前来检查的患者（多数为非糜烂性疾病）。采用无导管系统在4种饮食条件下对食管pH值进行4天监测。随机提供高脂肪（50%）与低脂肪（25%）饮食（热量控制），以及高热量（1000千卡）与低热量（500千卡）饮食（脂肪控制），并控制进餐量。同时研究了食物稠度的影响。
15例患者（6例男性，9例女性；年龄48岁；范围26 - 70岁；体重指数26kg/m²；体重指数范围21 - 35kg/m²）有完整数据。人口统计学变量和进餐顺序对反流参数无影响。饮食组成对食管酸暴露（F统计量[方差分析]=7.4，P<.005）和症状（Friedman检验=24.2，P<.001）有影响。食物稠度无影响。高热量饮食期间食管酸暴露高于低热量饮食（平均pH<4/24小时的时间为8.6%±2.0%对5.2%±1.4%；P<.01）。高脂肪和低脂肪饮食之间未观察到差异（平均pH<4/24小时的时间为8.6%±2.0%对8.2%±1.6%；P=无显著性差异）。相比之下，反流症状频率不受热量密度影响（中位数6；范围2 - 12对中位数8；范围2 - 13；P=无显著性差异），但高脂肪饮食比低脂肪饮食时增加（中位数11；范围5 - 18对中位数6；范围2 - 12；P<.05）。
热量密度决定餐后胃食管反流病食管酸暴露的严重程度；然而，饮食中的脂肪含量百分比对反流症状频率有重要影响。
