Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women 【关键词】 Symptoms, 关键词】 ABSTRACT Background Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI) ― the weight in kilograms divided by the square of the height in meters ― and symptoms of gastroesophageal reflux disease in persons of normal weight has not been demonstrated. Methods In 2000, we used a supplemental questionnaire to determine the frequency, severity, and duration of symptoms of gastroesophageal reflux disease among randomly selected participants in the Nurses' Health Study. After categorizing women according to BMI as measured in 1998, we used logistic-regression models to study the association between BMI and symptoms of gastroesophageal reflux disease. Results Of 10,545 women who completed the questionnaire (response rate, 86 percent), 2310 (22 percent) reported having symptoms at least once a week, and 3419 (55 percent of those who had any symptoms) described their symptoms as moderate in severity. We observed a dose-dependent relationship between increasing BMI and frequent reflux symptoms (multivariate P for trend <
  0.0
  01). As compared with women who had a BMI of
  20.0 to
  22.4, the multivariate odds ratios for frequent symptoms were
  0.67 (95 percent confidence interval,
  0.48 to
  0.
  93) for a BMI of less than
  20.0,
  1.38 (95 percent confidence interval,
  1.13 to
  1.
  67) for a BMI of
  22.5 to
  24.9,
  2.20 (95 percent confidence interval,
  1.81 to
  2.
  66) for a BMI of
  25.0 to
  27.4,
  2.43 (95 percent confidence interval,
  1.96 to
  3.
  01) for a BMI of
  27.5 to
  29.9,
  2.92 (95 percent confidence interval,
  2.35 to
  3.
  62) for a BMI of
  30.0 to
  34.9, and
  2.93 (95 percent confidence interval,
  2.24 to
  3.
  85) for a BMI of
  35.0 or more. Even in women with a normal baseline BMI, an increase in BMI of more than
  3.5, as compared with no weight changes, was associated with an increased risk of frequent symptoms of reflux (odds ratio,
  2.80; 95 percent confidence interval,
  1.63 to
  4.
  82). Conclusions BMI is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women. Even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux. Gastroesophageal reflux disease, with hallmark symptoms of heartburn and acid regurgitation,1 is a common disorder, affecting up to 60 percent of persons at some time during the course of a year and 20 to 30 percent of persons at least weekly.2,3 Gastroesophageal reflux disease accounts for at least 9 million office visits to physicians in the United States each year and costs approximately $10 billion annually.4 Frequent or severe symptoms of gastroesophageal reflux disease are associated with time lost from work,5 impaired health-related quality of life,6 and esophageal adenocarcinoma,7 further emphasizing the clinical significance of this entity. Several cross-sectional studies and one meta-analysis have demonstrated a positive association between elevated body-mass index (BMI) ― the weight in kilograms divided by the square of the height in meters ― and symptoms of gastroesophageal reflux disease.8,9,10,11,12,13,14,15,16 However, in these previous studies, analyses were restricted to overweight and obese subjects, with those who had a BMI of less than 24 or less than 25 serving as a reference group. We sought to explore more fully the association between BMI and symptoms of gastroesophageal reflux disease by determining the relative risks among a broader range of categories of BMI and among persons with various degrees of frequency, severity, and duration of symptoms. Methods
The cohort of the Nurses' Health Study was established in 1976, when 121,700 female registered nurses, 30 to 55 years of age, completed a mailed questionnaire about risk factors for cancer and cardiovascular disease. Participants have subsequently received follow-up questionnaires every two years. In 2000, a supplemental questionnaire about gastroesophageal reflux disease was sent to 11,080 participants with asthma and chronic obstructive pulmonary disease (COPD) and 11,080 randomly selected controls. For this analysis of BMI, the study population consisted of 11,080 control participants without asthma or COPD plus 1112 randomly selected women with airway disease (to represent the percentage of the entire Nurses' Health Study cohort with these conditions), for a total population of 12,192 women. The supplemental questionnaire inquired about the frequency, severity, and duration of heartburn and acid regurgitation. We defined symptoms of gastroesophageal reflux disease as the presence of heartburn, acid regurgitation, or both. Heartburn was defined as "a burning pain or discomfort behind the breast bone in your chest," and acid regurgitation as "a bitter or sour-tasting fluid coming into your throat or mouth," definitions that have been validated previously.17 The frequency of symptoms was reported as none in the past year, less than once a month, about once a month, about once a week, several times a week, and daily. We considered symptoms occurring once a week or more as frequent. Severity of symptoms was reported as mild ("can be ignored if I don't think about it"), moderate ("cannot be ignored but does not affect my lifestyle"), severe ("affects my lifestyle"), and very severe ("markedly affects my lifestyle"). Participants were also asked for the year when their symptoms began, whether they were awakened at night by symptoms, and whether they were taking antacid, antisecretory, or gastric-motility agents. We determined BMI from measurements of height provided by participants in the 1976 Nurses' Health Study questionnaire and from measurements of weight in the 1998 questionnaire. A 1980 questionnaire was used to obtain participants' weight at the age of 18 years. Waist and hip measurements were self-reported in 19
  86. The smoking status and history of diabetes mellitus were obtained in 1976 and updated every two years thereafter. Use of antihypertensive and asthma medication was assessed with the 1998 questionnaire. Menopausal status and use of postmenopausal hormones were determined in 1976 and updated every two years thereafter. Dietary information, including intake of coffee, tea, and alcohol, and information about physical activity were obtained in 19
  98. Each activity reported was measured in metabolic-equivalent (MET) hours per week. One MET represents the energy expended during one hour of rest. Self-reported BMI, waist and hip measurements, age at menopause, dietary information, and physical activity have been validated previously.18,19 Women were categorized according to BMI (<
  20.0,
  20.0 to
  22.4,
  22.5 to
  24.9,
  25.0 to
  27.4,
  27.5 to
  29.9,
  30.0 to
  34.9, and
  35.
  0). We used age- and multivariate-adjusted unconditional logistic regression to obtain odds ratios and 95 percent confidence intervals for the risk of reporting frequent symptoms of gastroesophageal reflux disease. For these analyses, women with a BMI of
  20.0 to
  22.4 served as the reference population. A test for trend across the categories of interest (e.g., BMI) was calculated by treating each category as an ordinal variable in the multivariate model. Potentially confounding variables included age; cigarette smoking (never smoked, former smoker, or current smoker); total daily activity in MET per week; total daily caloric intake; the number of drinks of alcohol, coffee, and tea per day; servings of chocolate per day; use of postmenopausal hormone therapy (premenopausal use, never any use, former use, current use of estrogen only, or current use of estrogen plus progesterone); use of antihypertensive or asthma medication; and presence or absence of a history of diabetes. To maximize the specificity of symptoms of gastroesophageal reflux disease for our primary analyses, we considered only participants with frequent symptoms and excluded women with symptoms less frequent than weekly. We analyzed the association between BMI and symptoms of gastroesophageal
reflux disease on the basis of severity and duration. We performed two analyses specifically to detect the presence of reverse causality between BMI and symptoms of gastroesophageal reflux disease (i.e., that reflux symptoms result in increased BMI). In one, we limited the analysis to women reporting symptoms for less than five years according to their BMI in 1994 (six years before the assessment of symptoms). In the second analysis, we studied women reporting at least 10 years of symptoms and used their 1984 BMI (16 years before the assessment of symptoms). Further analyses examined the associations between BMI and nocturnal symptoms of gastroesophageal reflux disease and between the waist-to-hip ratio and such symptoms. The attributable risks of symptoms of gastroesophageal reflux disease due to adiposity were calculated with multivariate relative risks (in this case, odds ratios) with the use of the formula (RR
  1)÷RR, where RR is the relative risk, and with a BMI of
  20.0 to
  22.4 as the referent. We evaluated the effect of weight change on symptoms by calculating the change in BMI between 1984 and 1998 and between age 18 and 19
  98. Women with missing BMI data were excluded from the analyses. We conducted all analyses with the use of SAS software (version
  8.
  2); two-sided P values of less than
  0.05 were considered to indicate statistical significance. The study was approved by the institutional review board of Brigham and Women's Hospital. Results A total of 10,545 participants returned the questionnaire about gastroesophageal reflux disease (response rate, 86 percent). Of these, 2497 (24 percent) reported having symptoms of gastroesophageal reflux disease less than once a month, 1302 (12 percent) once a month, 986 (9 percent) once a week, 1027 (10 percent) several times a week, and 297 (3 percent) daily. Frequency was missing for 106 women (2 percent). Therefore, 6215 women (59 percent) had symptoms and 2310 (22 percent) reported having symptoms at least once a week and were considered to have frequent episodes of gastroesophageal reflux disease. Of the women with symptoms, 3394 (55 percent) reported having both heartburn and acid regurgitation. No heartburn or acid regurgitation was reported in the previous year by 4330 women (41 percent), but 414 of these asymptomatic women reported taking medications often used for symptoms of gastroesophageal reflux disease, such as proton-pump inhibitors. To avoid potential misclassification, these women were excluded from the analysis, leaving 3916 women who were categorized as noncases. Of the women with symptoms of gastroesophageal reflux disease, 3419 (55 percent) described their symptoms as moderate in severity, 2396 (39 percent) as mild, 273 (4 percent) as severe, and 30 (<1 percent) as very severe. Data about severity were missing for 97 women (2 percent). Information about the year of onset of symptoms was available for only 2765 (44 percent) of the women. Among those who provided information about duration, 1180 (43 percent) had had symptoms of gastroesophageal reflux disease for less than 5 years, 400 (14 percent) had had symptoms for 5 to 9 years, and 1185 (43 percent) had had symptoms for at least 10 years. Characteristics of participants with frequent symptoms of gastroesophageal reflux disease and of those without symptoms are presented in Table
  1. Women with frequent symptoms were more likely than women without symptoms to have a higher BMI, to have used hormone therapy or asthma or antihypertensive medications, to have a greater daily caloric intake, and to be less active. At the time of the survey, women with gastroesophageal reflux disease were less likely to be current smokers but more likely to be former smokers than those without symptoms. Dietary factors such as the consumption of alcohol were similar between the two groups. Table
  1. Characteristics of Women with and Women without Symptoms of Gastroesophageal Reflux Disease.
A dose-dependent relationship was observed between increasing BMI and frequent reflux symptoms in both univariate and multivariate analyses (Figure
  1). This relationship continued across all categories of BMI, including those less than
  25.
  0. Women with a BMI of
  22.5 to
  24.9 were approximately 40 percent more likely to report frequent symptoms of gastroesophageal reflux disease than women with a BMI of
  20.0 to
  22.4, whereas overweight and obese women (BMI,
  25.0 to
  30.0 and
  30.0, respectively) were two to three times as likely to report frequent symptoms. Women in the lowest category of BMI (<
  20.
  0) had a lower risk of frequent symptoms of gastroesophageal reflux disease than did those with a BMI of
  20.0 to
  22.4 (multivariate odds ratio,
  0.67; 95 percent confidence interval,
  0.48 to
  0.
  93). Figure
  1. Association between Body-Mass Index and the Risk of Frequent Symptoms of Gastroesophageal Reflux Disease. Multivariate odds ratios are based on 2306 women who had symptoms (i.e., heartburn, acid regurgitation, or both) at least once a week and 3904 women who had no symptoms and have been adjusted for age; smoking status; total activity; daily caloric intake; intake of alcohol, coffee, tea, and chocolate; use of postmenopausal hormone therapy; use of antihypertensive or asthma medication; and presence or absence of diabetes mellitus. I bars denote 95 percent confidence intervals. This same trend was observed among the entire pop
 

相关内容

英语医学杂志

   Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women 【关键词】 Symptoms, 关键词】 ABSTRACT Background Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI) the weig ...

英语医学论文英文医学论文:在医学高专英语课堂引入医德教育的探讨

   英语医学论文英文医学论文: 在医学高专英语课堂引入医德教育的探讨 摘要:医德(medical ethics)是医学生日后从事医疗工作的职业道德 标尺,因而是医学生思想素质教育的重要环节。医德教育与英语课堂 这两个表明看起来并不明显相关的环节,但笔者认为只要能够将两者 进行有机结合、融会贯通,是可以起到一箭双雕的效果的。笔者在英 语教育实践中,尝试在课堂引入了以医德为主题的讨论,通过提问、小 组讨论、集中发言及总结等步骤,使学生既加深对道德伦理的认识,又 巩固了单词、短语及句子的英语知识,该法 ...

英语

   2010 年 1 月版开放英语 1 形成性考核册参考答案 月版开放英语 成性考核册参考答案 学前记录卡 根据自己实际情况填写,只要写就有成绩。 根据自己实际情况填写,只要写就有成绩。 学习记录表 1 1. parents photos buses lives halves children women teeth 2. 注意频度副词在句子中有不同的位置。 注意频度副词在句子中有不同的位置。 1) 在动词 to be 之后: 之后: ) I’m often ill on planes. 2) ...

英语

   考研时从 10 月份开始准备,国庆后才开始买资料复习,从头到尾一共可能就三个月多点的 时间, 不过从一开始我就坚信自己会有一套行之有效的方法可以迅速攻克考研英语, 毕竟以 前在雅思和托福的英语考试上有了比较充分的感悟。 结果考出来 84 分,还算理想,证明自己的一些想法是符合实际的。为了回报沪江和朋友 们, 决心把自己在考研英语复习上的体会总结成详细的文字跟大家分享, 希望能够给大家一 点帮助。 文章会比较长,请有兴趣的朋友给点耐心看完,然后结合自己的想法来讨论一下,共同提 高。如果有任何问 ...

英语

   考研的英语复习是一个庞大的系统工程, 而且英语成绩的提高是一个循序渐进的 过程,所以英语的复习必须有一个整体的规划。根据本人的英语现状和考研英语 大纲制定四个阶段的复习计划。 个人现状:英语通过四六级考试,语法基础较好,但词汇量与阅读量不足,写作 能力较差。 一、1 月到 6 月。掌握大纲要求词汇,强化阅读。 词汇量是考研英语阅读能力和写作能力提高的根本。首先要注重记忆核心词汇, 重点的单词的含义相关短语,语法以及同义词、反义词等需要注意。某些词汇只 需记住意思即可。学习要循序渐进,不可急躁 ...

英语

   在英语教学中重视文化教育 浙江省湖州中学弁山校区英语组 姜海礁 [摘 要] 语言和文化有着密不可分的内在联系,英语文化的学习是英语课程的一个重要 组成部分。学习英语的过程就是对英语国家文化知识了解和掌握的过程,掌握英语必须跨 越英汉两种语言文化, 才能进行得体的交际, 所以教师在教学中必须重视英语文化的导入。 [关键词] 素质教育 文化教学 关键词] 跨文化交际 一、问题的提出 语言是文化的载体,是文化的主要表现形式,语言的本质差异就是文化差异。语言是 随着民族的发展而发展的, 它是社会民族 ...

英语

   据说这篇资料在人人网已经被收藏 30 多万次了,不知道是不是真的,不过既然有 很多人收藏,估计肯定有它的道理吧,呵呵,大家一起学习进步) (1)英语口语集锦 http://www.xingkoo.com/view_info_new/36/view_info-36855.html (2)100 句英语典句 http://www.xingkoo.com/view_info_new/31/view_info-31141.html (3)最让人心动的爱的英文表白 http://www.xingkoo ...

英语

   辜鸿铭,精通九国的语言文化,国学造诣极深,曾获赠博士学位达 13 个之多。他的思想影 响跨越 20 世纪的东西方,是一位学贯中西、文理兼通的学者,又是近代中学西渐史上的先 驱人物。 辜鸿铭 10 岁时就随他的义父??英人布朗跳上苏格兰的土地, 被送到当地一所著名的 中学,受极严格的英国文学训练。课余的时间,布朗就亲自教辜鸿铭学习德文。布朗的教法 略异于西方的传统倒像是中国的私塾。他要求辜鸿铭随他一起背诵歌德的长诗《浮士德》 。 布朗告诉辜鸿铭:“在西方有神人,却极少有圣人。神人生而知之,圣人 ...

英语

   学号课程号开始退出医院管理 医生编码 毕业院校 最高学历 学生信息年龄 月薪+津贴+奖金-医疗保险-养老保险 字符型(6) 字符型(30) 字符型(10) 实发工资 华中科技大学 外国语学院英语二学位教学计划 [ 作者:wzhw 来源:华中科技大学外国语学院 点击数:638 更新时间:2006-2-11 文章录入: wzhw ] 【字体: 】 课程名称 学时/学分 二下 (2-6 月) 二下暑假 (7 或 8 月) 32 开课时间 三上(9-次年 元月) 32 三下 (2-6 月) 三下暑假 ...

英语

   大学英语啊??说的是四六级?我想知道你是想掌握实用性的还是应试性的……四六级和真正的英语是背道而驰的,要想学真正的英语,出国用的,趁早丢了四六级,免得中毒……如果是国内发展,四六级就可以了 语法其实在高中已经全部学完了,你要是想加强语法,我相信你肯定有老师发给你们的什么高考冲刺之类的复习书吧?看语法,再把里面的选择题全部好好做完,把错题全部弄懂,为什么错了,相信我,你的语法一定会很牛…… 四六级的关键在于听力和阅读,特别是听力,建议采用精听和泛听,精听就是把重要的单词能写下来的那种,泛听就是大 ...

热门内容

实用英语词汇与句子

   实用英语词汇与句子 在机场 常用语句 对不起,哪里是行李提领区? Excuse me, where is the baggage claim area? 行李遗失申报处在哪里? Where is the lost luggage office? 我可以在哪里找到行李推车? Where can I get a luggage cart? 基础词汇 行李 Baggage/Luggage 托运的行李 Checked baggage 行李领取处 Baggage claim area 随身行李 Car ...

少儿英语游戏

   少儿英语游戏 1、 弹钢琴 绝对经典的课堂游戏,找几个同学拿着单词卡,教师说哪个单词,哪个拿着那个单词的学生就蹦 一下,并且读一下那个单词,既让孩子读了又练了反映能力,经久不衰的课堂游戏。 2、萝卜蹲坑 和弹钢琴的玩法一样,不过是由向上蹦改为向下蹲,同样的游戏,变一下玩法就会有不同的效果。 3、拍卡片 把几个单词写在黑板上,找几个同学上黑板上,教师说哪个单词,学生就去拍并且读出来,比比看 谁快。 4、鸵鸟游戏 两个同学背对背,教师在其后背各放两张卡片,数 123,学生同时转身看对方的单词,谁 ...

试题绍兴市初卷中英语学科教改项目选题试

   绍兴市初中英语学科教改项目选题指南 注:本指南涉及:教学内容、教学方法、学习方法、评价、课程资源开发和教 本指南涉及:教学内容、教学方法、学习方法、评价、 师发展等多方面的内容。有些课题还可以再细化,有些还可以再深入。 师发展等多方面的内容。有些课题还可以再细化,有些还可以再深入。我们希 望通过提出本指南给老师们的教学研究提供一点参考, 望通过提出本指南给老师们的教学研究提供一点参考,也希望老师能结合自身 的教学实践不断地丰富和完善本指南内容, 的教学实践不断地丰富和完善本指南内容,并通过发 ...

关于职业装的英语词汇

   关于职业装的英语词汇 The byword for dress in the Western business world is conservative. This means nothing too flashy, too provocative, too casual, too tight or too revealing. 西方商界对于上班着装的观念比较保守,指衣服不能太浮华,太张扬,太随便,太紧或太暴露. For the ladies, the following dress it ...

剑桥少儿英语三级 句型复习集锦

   剑桥少儿英语三级 句型复习集锦 来源:本站原创 2009-12-03 15:40:12 [标签:剑少三级 复习 剑桥少儿英语 句型] 1.what What was the weather like yesterday ? It was …? What is your favourtite season ? you What’s the matter with you ? Spring . I have a cold . What will you do if you are hungry ...