Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176 Stockholm, Sweden.
World J Gastroenterol. 2012 Jul 28;18(28):3710-4. doi: 10.3748/wjg.v18.i28.3710.
To clarify the association between physical activity and gastroesophageal reflux disease (GERD) in non-obese and obese people.
A Swedish population-based cross-sectional survey was conducted. Participants aged 40-79 years were randomly selected from the Swedish Registry of the Total Population. Data on physical activity, GERD, body mass index (BMI) and the covariates age, gender, comorbidity, education, sleeping problems, and tobacco smoking were obtained using validated questionnaires. GERD was self-reported and defined as heartburn or regurgitation at least once weekly, and having at least moderate problems from such symptoms. Frequency of physical activity was categorized into three groups: (1) "high" (several times/week); (2) "intermediate" (approximately once weekly); and (3) "low" (1-3 times/mo or less). Analyses were stratified for participants with "normal weight" (BMI < 25 kg/m²), "overweight" (BMI 25 to ≤ 30 kg/m²) and "obese" (BMI > 30 kg/m²). Multivariate logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounding by covariates.
Of 6969 eligible and randomly selected individuals, 4910 (70.5%) participated. High frequency of physical activity was reported by 2463 (50%) participants, GERD was identified in 472 (10%) participants, and obesity was found in 680 (14%). There were 226 (5%) individuals with missing information about BMI. Normal weight, overweight and obese participants were similar regarding distribution of gender and tobacco smoking status, while obese participants were on average slightly older, had fewer years of education, more comorbidity, slightly more sleeping problems, lower frequency of physical activity, and higher occurrence of GERD. Among the 2146 normal-weight participants, crude point estimates indicated a decreased risk of GERD among individuals with high frequency of physical activity (OR: 0.59, 95% CI: 0.39-0.89), compared to low frequency of physical activity. However, after adjustment for potential confounding factors, neither intermediate (OR: 1.30, 95% CI: 0.75-2.26) nor high (OR: 0.99, 95% CI: 0.62-1.60) frequency of physical activity was followed by decreased risk of GERD. Sleeping problems and high comorbidity were identified as potential confounders. Among the 1859 overweight participants, crude point estimates indicated no increased or decreased risk of GERD among individuals with intermediate or high frequency of physical activity, compared to low frequency. After adjustment for confounding, neither intermediate (OR: 0.75, 95% CI: 0.46-1.22) nor high frequency of physical activity were followed by increased or decreased risk of GERD compared to low frequency among nonobese participants. Sleeping problems and high comorbidity were identified as potential confounders for overweight participants. In obese individuals, crude ORs were similar to the adjusted ORs and no particular confounding factors were identified. Intermediate frequency of physical activity was associated with a decreased occurrence of GERD compared to low frequency of physical activity (adjusted OR: 0.41, 95% CI: 0.22-0.77).
Intermediate frequency of physical activity might decrease the risk of GERD among obese individuals, while no influence of physical activity on GERD was found in non-obese people.
阐明非肥胖和肥胖人群中身体活动与胃食管反流病（GERD）之间的关联。
进行了一项瑞典基于人群的横断面调查。从瑞典总人口登记处随机选择年龄在 40-79 岁的参与者。使用经过验证的问卷获得关于身体活动、GERD、体重指数（BMI）和协变量（年龄、性别、合并症、教育程度、睡眠问题和吸烟状况）的数据。GERD 通过自我报告定义为每周至少一次烧心或反流，且存在此类症状的中度或以上问题。身体活动频率分为三组：（1）“高”（每周几次）；（2）“中”（每周一次左右）；（3）“低”（每月 1-3 次或更少）。对于“正常体重”（BMI<25kg/m²）、“超重”（BMI 25 至≤30kg/m²）和“肥胖”（BMI>30kg/m²）的参与者进行分层分析。使用多变量逻辑回归计算优势比（OR）及其 95%置信区间（CI），并对潜在混杂因素进行了调整。
在 6969 名合格且随机选择的个体中，有 4910 名（70.5%）参与了研究。50%（2463 名）的参与者报告了高频率的身体活动，10%（472 名）的参与者出现了 GERD，14%（680 名）的参与者肥胖。有 226 名（5%）参与者的 BMI 信息缺失。在性别和吸烟状况分布方面，正常体重、超重和肥胖参与者相似，而肥胖参与者的平均年龄较大，受教育年限较少，合并症更多，睡眠问题略多，身体活动频率较低，且 GERD 发生率较高。在 2146 名正常体重参与者中，与低频率身体活动相比，高频率身体活动的 GERD 风险明显降低（OR：0.59，95%CI：0.39-0.89）。然而，在调整了潜在混杂因素后，中（OR：1.30，95%CI：0.75-2.26）或高（OR：0.99，95%CI：0.62-1.60）频率的身体活动与 GERD 风险降低无关。睡眠问题和高合并症被确定为潜在的混杂因素。在 1859 名超重参与者中，与低频率身体活动相比，中或高频率身体活动的参与者出现 GERD 的风险无明显增加或降低。在调整了混杂因素后，与低频率相比，中（OR：0.75，95%CI：0.46-1.22）或高（OR：0.99，95%CI：0.62-1.60）频率的身体活动均未导致 GERD 风险增加或降低。睡眠问题和高合并症被确定为超重参与者的潜在混杂因素。在肥胖个体中，粗 OR 与调整后的 OR 相似，且未发现特定的混杂因素。与低频率的身体活动相比，中频率的身体活动与 GERD 的发生频率降低相关（调整后的 OR：0.41，95%CI：0.22-0.77）。
在肥胖人群中，中等频率的身体活动可能会降低 GERD 的风险，而在非肥胖人群中，身体活动对 GERD 没有影响。
