Pro- and Anti-Inflammatory Dietary Patterns and Lifestyle Factors Associated with Gastroesophageal Reflux Symptoms in Romanian Adults: A Cross-Sectional Study

2.1. Study Design and Participants

A cross-sectional research was carried out utilizing a self-administered on-line questionnaire distributed to adults (≥18 years) residing in Romania.

All members reported a previous analysis of GERD; nonetheless, symptom standing assorted on the time of questionnaire completion. Therefore, members had been categorized strictly based mostly on their present symptom standing utilizing the GERD-Q rating (≥8 vs. <8), whereas all had a previous analysis of GERD. This strategy doesn’t signify a case–management design, however moderately a comparability between members at completely different levels of symptomatic expression throughout the identical underlying situation.

Data had been collected on-line by way of the Google Forms platform between December 2025 and January 2026. All members had been knowledgeable in regards to the objective of the research and supplied knowledgeable consent via the voluntary and nameless completion of the questionnaire; no separate written consent was required as a result of nameless on-line format.

The on-line questionnaire platform didn’t gather identifiable private information. IP addresses weren’t saved or accessible to the researchers, making certain the anonymity of the responses. Additionally, duplicate responses had been minimized via questionnaire settings proscribing a number of submissions from the identical gadget/session; nonetheless, full elimination of duplicate entries can’t be totally assured in nameless on-line surveys.

2.2. Recruitment Strategy and Participant Flow

Participants had been recruited by distributing the questionnaire via related help teams and group pages on social media platforms. A comfort sampling technique was employed within the on-line setting. To guarantee methodological transparency and justify the ultimate pattern measurement, the theoretical participant move was reconstructed from the estimated accessible inhabitants to acquire the specified closing variety of legitimate questionnaires for evaluation.

The participant inclusion course of adopted 5 sequential levels:

1. Potentially affected inhabitants: In Romania, an area research reported a GERD prevalence of 17% [8], which suggests an estimated 2–2.4 million affected people when utilized to the grownup inhabitants (~12 million). Based on this prevalence and the extent of engagement in on-line help networks and social media communities, it was estimated that roughly 50,000 people with GERD in Romania might be accessible for a web-based survey.

2. Survey invitation: It was estimated that roughly 10% of those people really considered the survey invitation, leading to an estimated 5000 folks.

3. Access to the questionnaire hyperlink: Applying hyperlink entry charges reported within the literature for on-line surveys (~20–25%), we estimated that 1120 people would entry the questionnaire.

4. Completed questionnaires: In on-line surveys, the proportion of accomplished questionnaires is often reported to vary between 35% and 45%. Applying an approximate completion price of 40% resulted in a theoretical estimate of 448 accomplished questionnaires, which is near the precise variety of responses obtained (n = 412).

5. Inclusion/exclusion standards: Application of the inclusion standards (age ≥ 18 years, residence in Romania, totally accomplished questionnaire, and legitimate responses to GERD-Q objects) led to the exclusion of 72 questionnaires, leading to 340 legitimate questionnaires, which constituted the ultimate dataset for statistical evaluation. The exclusion standards included age < 18 years, incomplete questionnaires, and inconsistent responses.

The intermediate levels (invitation publicity and hyperlink entry) signify estimates based mostly on the present literature relating to response charges in on-line surveys [14,15], whereas the ultimate levels (variety of accomplished and legitimate questionnaires) replicate the precise information obtained for the research (Figure 1).

As the recruitment technique was based mostly on the voluntary participation of individuals energetic in on-line communities, the research pattern might embrace people at completely different levels of illness expression and symptom severity, together with each symptomatic and asymptomatic members regardless of a previous GERD analysis. This heterogeneity in symptom standing might have influenced group classification and must be thought-about when deciphering the findings.

2.3. Study Instrument and Pilot Testing

The main research instrument was the GERD-Q questionnaire, which has been internationally validated for the evaluation of typical gastroesophageal reflux signs [12]. In this research, the usual GERD-Q objects had been built-in into an prolonged questionnaire. The questionnaire comprised 42 objects and investigated the next domains: demographic information, dietary standing, typical and related reflux signs, dietary consumption of pro- and anti inflammatory meals teams, consumption of potential set off meals, consuming behaviors, and lifestyle-related components.

The questionnaire was pre-tested on a pilot pattern of 30 respondents to evaluate merchandise readability. Internal consistency was evaluated utilizing Cronbach’s alpha coefficient (α = 0.87), and inter-item correlation was assessed utilizing Spearman’s correlation coefficient (r = 0.83), indicating good inside reliability. The common time required to finish the questionnaire was roughly 25–30 min.

Although the prolonged questionnaire used on this research didn’t bear formal exterior validation, the pilot testing and inside consistency indicators counsel that it’s adequately dependable for exploratory analyses inside an observational research design.

2.4. Assessment of GERD Symptoms

The evaluation of GERD signs included standardized objects exploring the frequency and depth of typical and related manifestations of gastroesophageal reflux, in accordance with the construction of an internationally validated instrument (GERD-Q) [13].

1. Typical signs had been evaluated, specifically, heartburn (a retrosternal burning sensation) and regurgitation (the feeling of gastric contents returning into the throat or mouth).

2. Associated signs had been evaluated: epigastric ache; nausea; and reflux-related sleep disturbances, together with issue falling asleep or nocturnal awakenings attributable to signs.

Symptom frequency was assessed on a scale starting from 0 to 4 factors (“never” to “4–7 days/week”). Based on this stuff, the next outcomes had been derived: (1) the presence of GERD-type signs, outlined because the incidence of typical signs at the least twice per week, in line with the Montreal definition [4], and (2) a symptom severity rating, which was obtained by summing the scores for heartburn, regurgitation, epigastric ache, and sleep disturbances (theoretical vary: 0–16 factors) and subsequently used to categorise delicate, average, and extreme symptom types.

For all comparative analyses and logistic regression fashions, members had been categorized based mostly on their present symptom standing utilizing the GERD-Q rating (≥8 vs. <8), reflecting the presence or absence of present GERD symptomatology. This cutoff was outlined when the questionnaire was first developed and has been proven to supply a great steadiness between sensitivity and specificity for figuring out GERD in medical and epidemiological settings [13]. The definition of typical signs in line with the Montreal consensus (signs occurring at the least twice per week) was used just for descriptive functions; it was not utilized as a classification variable within the statistical analyses.

2.5. Sociodemographic, Anthropometric, and Lifestyle Variables

The questionnaire collected the next information:

• (a)

  Demographic traits—age, intercourse, and space of residence (city/rural)—had been collected.

• (b)

  Information on dietary standing—assessed utilizing physique mass index (BMI), which was calculated as weight divided by top squared (kg/m²)—was collected. Participants’ BMI values had been calculated based mostly on self-reported information, and the research inhabitants was categorized in line with the World Health Organization (WHO) classification [15] as follows: (1) underweight (<18.5 kg/m²); (2) regular weight (18.5–24.9 kg/m²); (3) obese (25.0–29.9 kg/m²); (4) weight problems class I (30.0–34.9 kg/m²); (5) weight problems class II (35.0–39.9 kg/m²); and (6) weight problems class III (≥40.0 kg/m²).

• (c)

  Lifestyle-related behaviors had been collected. The questionnaire included a set of things addressing every day behaviors identified to affect GERD symptomatology: (1) smoking standing (non-smoker, occasional smoker, and every day smoker, with subcategories based mostly on the common variety of cigarettes smoked per day); (2) variety of important meals and snacks consumed per day; (3) most well-liked methodology of meals preparation (home-cooked meals, semi-prepared meals, or quick meals); (4) meal timing, together with the timing of the final meal relative to bedtime and the frequency of consuming massive night meals (explicit consideration was paid to adherence to making sure there’s a ≥2 h interval between dinner and bedtime); and (5) traditional sleeping place (left/proper lateral decubitus, supine, susceptible, or with the higher physique elevated), contemplating present proof on the affect of sleep place on nocturnal reflux.

The evaluation of those variables enabled the identification of doubtless modifiable behavioral components related to the onset or exacerbation of GERD signs.

For statistical evaluation, a number of variables had been recoded based mostly on the present literature and medical relevance. Alcohol and low consumption had been dichotomized as <3 instances/week versus ≥3 instances/week. Reflux-related sleep disturbances had been recoded into two classes (absent—by no means/hardly ever; current—generally/typically/fairly often). Sleeping place was categorized as reflux-favorable (left lateral decubitus or with a mildly elevated higher physique) or reflux-unfavorable (supine, susceptible, or proper lateral decubitus). The frequency of enormous night meals was recoded because the frequency of consuming non-large meals (by no means/hardly ever) and huge meals (often/at all times). The interval between the final meal and sleep was categorized as ≥2 h versus <2 h. Additionally, a composite variable with 4 classes was generated to evaluate the cumulative impact of meal quantity and timing (non-large + ≥2 h; non-large + <2 h; massive + ≥2 h; and huge + <2 h).

2.6. Dietary Assessment and Food Frequency Recoding

Dietary consumption evaluation included objects designed to research the consumption of assorted meals teams with pro- and anti inflammatory potential. Responses had been initially coded on an ordinal scale starting from 0 to 9 in line with consumption frequency (from “never” to “six or more times per day”), permitting for subsequent quantification of the dietary pro- and anti inflammatory load scores.

For dietary consumption evaluation, the unique 10-point frequency scale was aggregated right into a 5-level ordinal scale: 1 = by no means; 2 = distinctive (occasional); 3 = 1–2 instances per week; 4 = 3–4 instances per week; and 5 = every day. This recoding was utilized to forestall imbalance within the response distribution throughout classes, enhance the soundness of statistical fashions (correlation analyses and multivariable regression), and facilitate epidemiological interpretation of the info with out lack of clinically related info (Table 1).

The recoded scores had been subsequently utilized in correlational and multivariable analyses to judge the connection between dietary profiles and the severity of gastroesophageal reflux illness (GERD) signs.

2.7. Construction of Dietary Scores

Food teams with a documented potential to set off or exacerbate reflux signs had been investigated based mostly on proof from the literature. These meals teams included high-fat meals (animal fat, fried meals, and quick meals), chocolate, espresso and different caffeinated drinks, carbonated drinks, alcoholic drinks, citrus fruits, tomatoes and tomato-based merchandise, and spicy meals.

In addition, the questionnaire included a definite set of things addressing the consumption of meals with potential anti-inflammatory properties: recent fruits (excluding citrus fruits), greens (excluding tomatoes), fish (together with omega-3–wealthy species akin to salmon, mackerel, and sardines), fermented dairy merchandise (yogurt, kefir, and cultured milk merchandise), complete grains, and vegetable oils.

These meals teams had been chosen based mostly on proof from current research linking the next consumption of fiber, antioxidants, polyunsaturated fatty acids, and polyphenols to reductions in oxidative stress and systemic irritation [11,16].

These dietary scores had been constructed particularly for this research based mostly on proof from the literature relating to meals with pro- and anti inflammatory potential, they usually had been used as exploratory indicators of total dietary patterns.

The PRO and ANTI scores used on this research will not be beforehand validated indices; they had been developed particularly for this research based mostly on proof from the literature relating to meals with pro- and anti inflammatory or reflux-related potential. Each meals group was given equal weight to replicate the cumulative contribution of the general dietary sample moderately than the remoted results of particular person meals. The threshold of ≥3 instances per week was chosen to seize ordinary consumption, according to frequency cutoffs generally utilized in observational dietary research.

This strategy allowed for the identification of total dietary patterns and the evaluation of meals with documented pathophysiological relevance to gastroesophageal reflux, which had been subsequently correlated with reported symptom severity.

2.8. Statistical Analysis

Data had been initially entered right into a Microsoft Excel 2013 database and subsequently exported for statistical evaluation utilizing SPSS model 20 and R model 4.3.3.

The analyses included descriptive statistics to characterize the research pattern, comparative checks (Student’s t check, χ² check, the Kruskal–Wallis check, and ANOVA) to evaluate variations between teams, and correlational analyses (Pearson and Spearman), relying on the distribution of the variables.

The normality of quantitative variables (age, weight, top, variety of important meals and every day snacks, and frequency of bodily exercise) was assessed utilizing the Kolmogorov–Smirnov check. To establish unbiased predictors of GERD symptom presence, multivariable logistic regression fashions had been constructed, together with variables chosen based mostly on medical relevance and univariate associations, with adjustment for potential confounders. The threshold for statistical significance was set at p < 0.05.

3.1. Sample Characteristics

The outcomes must be interpreted within the context of the research design and potential sources of bias, together with choice bias associated to on-line recruitment, self-selection of symptomatic people, and the usage of self-reported information.

The imply age of the members was 49.3 ± 18.6 years, with a median age of 48 years. Among ladies, the imply age was 48.17 ± 18.31 years, whereas that amongst males was 52.80 ± 19.04 years.

Of the 340 members included within the evaluation, 246 (72.4%) offered present GERD signs (GERD-Q rating ≥ 8), whereas 94 (27.6%) had no present symptomatology (GERD-Q rating < 8) regardless of a previous analysis of GERD (Table 2).

No statistically vital variations had been noticed between members with present GERD signs and people with out present symptomatology with respect to intercourse, space of residence, or imply age (all p-values > 0.05). The distribution of present GERD symptom standing throughout age teams (<30 years, 30–49 years, ≥50 years) didn’t reveal any vital associations (p = 0.282) (Table 3). These findings point out that age was not an explanatory issue for present GERD symptomatology on this pattern.

3.2. Association Between Anthropometric Characteristics and GERD Status

Comparative evaluation of anthropometric variables didn’t reveal vital variations between the members with and with out GERD. Body weight, top, and physique mass index (BMI) values had been comparable between the 2 teams (all p values > 0.05).

The distribution of members throughout BMI classes indicated that just about half of the respondents had been regular weight (48.0%), whereas the remaining members had been categorized as obese (19.7%) or overweight (class I: 14.4%; class II: 17.6%; class III: 0.3%). No underweight members had been recognized within the pattern.

The χ² check was used to judge variations in BMI class distribution between teams. It didn’t reveal a major affiliation between BMI class and GERD standing (p = 0.533).

Odds ratio evaluation, utilizing the normal-weight class because the reference, didn’t establish statistically vital associations between obese or weight problems and the presence of GERD, with confidence intervals together with the null worth of 1.

3.3. Association Between Smoking, Alcohol Consumption, and Coffee Consumption and GERD Status

The distribution of smoking standing didn’t reveal statistically vital variations between members with present GERD signs and people with out present symptomatology (p = 0.351). To assess the potential impact of every day tobacco publicity, smoking standing was recoded right into a binary variable evaluating every day people who smoke with non-smokers and occasional people who smoke. This evaluation additionally didn’t exhibit a major affiliation between every day smoking and present GERD symptomatology (p = 0.117).

Regarding alcohol consumption, consumption frequency was predominantly by no means or low throughout the research pattern. Comparative analyses didn’t point out vital variations between the members with present GERD signs and people with out present symptomatology (p = 0.823). After alcohol consumption was recoded utilizing a ≥3 instances/week threshold, the proportion of members with present GERD signs was barely greater amongst frequent shoppers; nonetheless, this distinction didn’t attain statistical significance (p = 0.431), and odds ratio evaluation didn’t point out a major unbiased affiliation.

Similarly, espresso consumption frequency was not considerably related to present GERD symptomatology (p = 0.367). After espresso consumption was recoded (<3 vs. ≥3 instances/week), the evaluation confirmed a statistically non-significant development towards a decrease proportion of members with present GERD signs amongst frequent espresso shoppers (OR = 0.62; 95% CI: 0.37–1.03), with out reaching the edge for statistical significance (p = 0.077).

Overall, neither smoking nor alcohol or espresso consumption was independently related to present GERD symptomatology in univariate analyses (Table 4).

3.4. Association Between Sleep-Related Factors and GERD Status

The evaluation of sleep-related components didn’t reveal statistically vital associations with the presence of GERD. Reflux-related sleep disturbances didn’t differ considerably between members with and with out GERD (p = 0.400). After the variable was recoded right into a binary kind (no sleep disturbances vs. presence of sleep disturbances), GERD prevalence was 76.5% amongst members with out sleep disturbances and 70.1% amongst these reporting sleep disturbances; this distinction didn’t attain statistical significance (p = 0.233). Odds ratio evaluation didn’t point out a major affiliation between sleep disturbances and the presence of GERD (OR = 0.72; 95% CI: 0.43–1.21).

Similarly, sleeping place was not considerably related to GERD standing (p = 0.844). After sleeping place was recoded into reflux-favorable positions (left lateral decubitus or mildly elevated higher physique) versus reflux-unfavorable positions (supine, susceptible, or proper lateral decubitus), the variations remained non-significant (OR = 0.74; 95% CI: 0.47–1.18; p = 0.19).

Overall, neither reported sleep disturbances nor recoded sleeping place had been independently related to the presence of GERD in univariate analyses (Table 5).

3.5. Association Between Late Meals and GERD Status

Adherence to a schedule through which there was an interval of at the least two hours between the final meal and bedtime was considerably related to GERD standing (p = 0.030). The members who consumed meals lower than two hours earlier than going to sleep exhibited the next prevalence of GERD in contrast with those that persistently revered this interval.

In the recoded evaluation (≥2 h vs. <2 h), late meals had been related to a considerably elevated threat of GERD (OR = 2.05; 95% CI: 1.25–3.37; p = 0.030) (Table 6).

3.6. Association Between Large Evening Meals and GERD Status

The evaluation of the frequency distribution of enormous night meals didn’t reveal a statistically vital affiliation with the presence of GERD (p = 0.698). After we recoded the variable right into a binary kind (massive night meals reported often/at all times vs. hardly ever/by no means), the affiliation remained non-significant, and odds ratio evaluation didn’t point out an elevated chance of GERD amongst members who reported consuming massive night meals (OR = 1.25; 95% CI: 0.77–2.02; p = 0.35).

3.7. Cumulative Impact of Meal Volume and Late Meal Timing on GERD

The mixed evaluation of meal quantity and timing of the final meal earlier than bedtime demonstrated a statistically vital affiliation with the presence of GERD (p = 0.030).

Participants who reported consuming massive meals lower than two hours earlier than bedtime exhibited the best prevalence of GERD (80.2%), with a considerably elevated threat in contrast with the reference group (OR = 2.16; 95% CI: 1.18–3.97; p = 0.012) (Table 7).

3.8. Association Between Individual Food Consumption and GERD (Univariate Analysis)

The univariate evaluation of associations between frequent meals consumption (≥3 instances/week) and the presence of GERD included meals teams thought-about protecting/anti-inflammatory and people considered aggravating components for gastroesophageal reflux.

3.9. Association Between Current GERD Symptomatology and Pro- and Anti-Inflammatory Dietary Scores

The distribution of the composite dietary scores (PRO, ANTI, and PRO–ANTI) throughout the research pattern is offered under. Dietary scores had been analyzed utilizing categorized ranges reflecting low, average, and excessive dietary publicity.

The PRO rating was recoded into three dietary classes. The majority of members offered a average PRO rating (65.0%), whereas 21.5% had a excessive PRO rating ≥ 6 pro-inflammatory meals objects consumed often), and 13.5% had a low PRO rating.

Regarding the ANTI rating, most members (75.6%) had been categorized throughout the average class, whereas 13.5% offered a excessive ANTI rating, and 10.9% had a low ANTI rating.

The dietary steadiness rating (PRO–ANTI) was recoded into 4 classes to explain the general dietary patterns. The participant distribution was as follows: 14.1% had a predominantly anti-inflammatory profile (≤−2), 25.6% had a comparatively balanced profile (−1 to 0), 35.6% had a reasonably pro-inflammatory profile (1–2), and 24.7% had a predominantly pro-inflammatory profile (≥3).

The affiliation between total dietary patterns and present GERD symptomatology was subsequently evaluated utilizing multivariable logistic regression fashions, adjusted for demographic, anthropometric, and behavioral components.

The associations between composite dietary scores and present GERD symptomatology are summarized in Table 9.

A statistically vital affiliation was recognized between classes of the pro-inflammatory dietary rating (PRO) and present GERD symptomatology (p = 0.048). The proportion of members with a excessive PRO rating (≥6) was better amongst members with present GERD signs in contrast with these with out present symptomatology (12.2% vs. 5.3%). Compared with the low-PRO-score class, a excessive PRO rating was related to an roughly threefold-higher chance of present GERD symptomatology (OR = 2.9).

In distinction, the anti-inflammatory dietary rating (ANTI) was not considerably related to present GERD symptomatology (p = 0.739), with an identical distribution of classes amongst members with and with out present symptomatology.

Analysis of the mixed PRO–ANTI rating didn’t reveal a major total affiliation with present GERD symptomatology (p = 0.775). Although the proportion of members categorized as having a predominantly pro-inflammatory profile was greater amongst members with present GERD signs in contrast with these with out present symptomatology (43.5% vs. 37.2%), this distinction didn’t attain statistical significance.

Given the numerous affiliation noticed for the PRO rating, composite dietary scores had been subsequently included in multivariable logistic regression fashions to judge the unbiased relationship between total dietary patterns and present GERD symptomatology, after adjustment for potential demographic, anthropometric, and lifestyle-related confounders.

3.10. Multivariable Analysis of Factors Associated with GERD

The variables that confirmed statistically vital associations or constant traits in univariate analyses had been included in multivariable logistic regression fashions to judge their unbiased relationships with the presence of gastroesophageal reflux illness (GERD).

In the dietary mannequin based mostly on the pro-inflammatory dietary rating (PRO), the PRO rating was independently and persistently related to the presence of GERD (Table 10). Compared with a low PRO rating, a average PRO rating was related to a considerably elevated threat of GERD each within the dietary mannequin adjusted for age and intercourse (OR = 2.12; 95% CI: 1.15–3.89; p = 0.016) and within the built-in dietary and behavioral mannequin (OR = 2.01; 95% CI: 1.08–3.73; p = 0.027). A excessive PRO rating was related to a fair better threat of GERD—exceeding a fourfold improve—in each the dietary mannequin (OR = 4.67; 95% CI: 1.58–13.78; p = 0.005) and the built-in mannequin (OR = 4.23; 95% CI: 1.42–12.62; p = 0.009).

Age emerged as an unbiased predictor of GERD in all the fashions analyzed, with every further yr being related to a modest however statistically vital improve in GERD threat (with ORs ranging between 1.02 and 1.03, and all p values had been < 0.05). Sex, physique mass index (BMI), and the anti-inflammatory dietary rating (ANTI) weren’t considerably related to the presence of GERD within the PRO-based fashions.

4.1. Association Between Pro-Inflammatory Dietary Patterns and the Presence of GERD

The most constant discovering of this research was the numerous affiliation between the pro-inflammatory dietary rating and the presence of GERD. Both univariate analyses and multivariable logistic regression fashions revealed a progressive improve within the threat of GERD with a rise in PRO rating, with members within the high-PRO class exhibiting an over fourfold-higher threat in contrast with these with a low PRO rating. This discovering means that within the studied pattern, GERD is extra strongly related to cumulative publicity to a number of meals teams with irritant or inflammatory potential than to the consumption of a single meals merchandise in isolation [17].

However, these scores must be interpreted as exploratory proxies for total dietary patterns moderately than standardized medical indices.

This statement is per the current literature, which has more and more moved away from a concentrate on remoted “trigger foods” towards the idea of total dietary patterns. Several research and literature syntheses point out that diets wealthy in fat (notably saturated fat) ultra-processed meals, and refined sugars are related to the next frequency of reflux signs and/or unfavorable physiological parameters [18,19,20,21]. For instance, El-Serag et al. reported associations between fats consumption and the presence of reflux signs in an observational research [19]. Similarly, Song et al. demonstrated that particular dietary patterns and consuming behaviors are related to the presence of GERD signs [20].

From a pathophysiological perspective, such dietary patterns might promote reflux via a number of mechanisms, together with gastric distension, alterations within the frequency of transient lower-esophageal-sphincter rest, and elevated esophageal acid publicity—mechanisms mentioned in physiological research and evaluations of way of life interventions [18,22,23]. Low-grade systemic irritation represents a believable mechanism for symptom amplification and has been mentioned within the context of dietary inflammatory indices [11]. Supporting this speculation, current cohort information point out {that a} greater pro-inflammatory dietary potential is related to an elevated threat of GERD [24]. In settlement with these findings, current potential research evaluating international dietary patterns have reported a decrease threat of GERD amongst people adhering to predominantly vegetarian diets in contrast with these with non-vegetarian dietary patterns [25].

The lack of an unbiased affiliation between the ANTI rating and GERD, alongside the persistent predictive worth of the PRO rating, means that the cumulative results of dangerous meals might outweigh the advantages of protecting meals when each coexist inside a combined dietary sample. This might clarify the lack of statistical significance noticed for the mixed PRO–ANTI rating in sure analyses.

Although some meals with potential protecting results, akin to fish, demonstrated favorable associations in univariate analyses, these results had been inadequate to counterbalance the general influence of frequent consumption of irritant, extremely processed, or high-fat meals. This discovering is per the speculation that dietary methods for GERD ought to focus not solely on the “addition” of wholesome meals but in addition on a scientific discount within the consumption of meals with pro-reflux potential.

Similar outcomes have been reported in research displaying that merely rising fruit and vegetable consumption is inadequate to alleviate signs if one’s total eating regimen stays wealthy in fat and ultra-processed merchandise [21,26,27].

These findings counsel that the function of particular person meals objects must be interpreted throughout the broader context of total dietary patterns.

4.2. Specific Role of Spicy Foods and Carbonated Beverages

Among the person meals objects, spicy meals and carbonated drinks had been the one ones considerably related to GERD within the univariate evaluation. Frequent consumption of this stuff was related to an roughly twofold-higher threat of GERD. These findings are per experimental information demonstrating that chemical stimulation of the esophagus with capsaicin can improve esophageal sensitivity and ache notion [28]. In addition, physiological research have proven that carbonated drinks might induce gastric distension and cut back lower-esophageal-sphincter strain [29]. A scientific overview of the literature additionally helps the existence of an affiliation between carbonated-beverage consumption and reflux signs [30].

However, the lack of statistical significance within the multivariable fashions means that these meals could also be markers of an total dietary sample moderately than unbiased threat components. This discovering highlights the significance of distinguishing between univariate associations and unbiased predictors recognized in multivariable fashions. This interpretation is supported by the persistence of the importance of behavioral components associated to meal timing after adjustment, highlighting the worth of composite dietary scores. These outcomes are according to conclusions from earlier research emphasizing that the results of diets on GERD are hardly ever attributable to a single meals merchandise [18,26].

4.3. Importance of Meal Timing and Cumulative Effect of Eating Behaviors

Another central discovering of this research is the constant affiliation between late meals (consumption of the final meal of the day lower than two hours earlier than bedtime) and the presence of GERD. This affiliation was vital in each univariate analyses and multivariable fashions, and it was additional bolstered by the mixed evaluation, which indicated that there was the next chance of GERD amongst members who reported each massive night meals and late meal timing. In line with these findings, the literature helps the function of the dinner-to-bedtime interval: a shorter interval between dinner and sleep was related to the next threat of GERD in a case–management research [31]. Moreover, evaluations specializing in way of life interventions embrace avoidance of late meals amongst measures related to symptom enchancment, notably nocturnal reflux [23].

Kaltenbach et al., within the American College of Gastroenterology (ACG) tips, establish the avoidance of late meals as one of many few behavioral interventions supported by strong physiological proof [31]. Similarly, Fujiwara and Arakawa demonstrated that the supine place mixed with elevated gastric contents might promote reflux via lack of the gravitational impact and decreased esophageal clearance [32].

The mixed evaluation on this research signifies that GERD signs are almost certainly to happen when late meals are mixed with a big meal quantity, suggesting a cumulative impact of meals quantity and a brief interval between the final meal and bedtime. This statement is supported by analysis displaying {that a} decreased dinner-to-bedtime interval is related to the next frequency of reflux episodes, notably nocturnal reflux, in addition to by experimental and medical research indicating that large-volume meals might improve intragastric strain and publicity to esophageal acid. Recent evaluations emphasize the function of night consuming habits, together with late meals and overeating, as modifiable threat components for GERD symptomatology [18,33,34]. Taken collectively, these findings emphasize the interaction between meal timing and meal quantity in regard to reflux threat.

The noticed affiliation for the mixed publicity (massive meals and late timing) possible displays a cumulative physiological impact, through which elevated gastric quantity and a shorter interval earlier than mendacity down act collectively to advertise reflux. This might clarify why every issue alone didn’t persistently attain statistical significance, whereas their mixture confirmed a stronger and extra constant affiliation.

The discovering that giant night meals analyzed in isolation weren’t considerably related to GERD however grew to become related when mixed with late meal timing means that meal quantity and timing have a synergistic impact. This statement has related medical implications. Synchronization of meals with the sleep–wake cycle seems to be probably extra related than an unique concentrate on meal amount or strict avoidance of particular person meals.

From a sensible perspective, these findings help the notion that avoiding the consumption of meals lower than two hours earlier than bedtime and lowering the dimensions of night meals are easy and simply relevant methods of assuaging reflux signs.

4.4. Classical Lifestyle Factors: Smoking, Alcohol Consumption, Coffee Consumption, and Sleeping Position

The lack of unbiased associations for smoking, alcohol consumption, espresso consumption, and sleeping place is per the up to date literature, which experiences heterogeneous and infrequently inconsistent findings. Conflicting outcomes relating to smoking and alcohol are additionally mirrored in current proof. Population-based cohort information counsel that the cessation of smoking could also be related to an enchancment in reflux signs [35]. However, the absence of a major affiliation between smoking and GERD on this research doesn’t exclude a possible medical relationship, however it could replicate limitations associated to pattern measurement, publicity variability, or behavioral diversifications amongst members. In distinction, meta-analyses addressing alcohol consumption point out that there’s a heterogeneous relationship, with substantial variability throughout research [36].

The noticed lack of statistically vital associations might replicate a number of components, together with the comparatively homogeneous distribution of those behaviors throughout the pattern, pre-existing behavioral diversifications amongst symptomatic people (e.g., decreased alcohol consumption), and the inherent limitations of self-reported measurements. Collectively, these findings counsel that within the present context, dietary patterns and meal-related behaviors might exert a extra direct influence on reflux signs than sure classical way of life components thought-about in isolation.

Similarly, espresso consumption was not considerably related to GERD on this research. A non-significant development towards a decrease prevalence of GERD amongst frequent espresso shoppers was noticed; nonetheless, this discovering might replicate residual confounding or behavioral diversifications amongst symptomatic people moderately than a real protecting impact.

With respect to sleeping place, current information point out that left lateral decubitus is related to decreased nocturnal acid publicity and improved esophageal clearance [37], findings which can be additionally supported by a current systematic overview [38]. Our outcomes counsel that the impact of sleeping place could also be outweighed by different dietary and behavioral components underneath real-life situations. This distinction could also be defined by the extra direct physiological influence of meal timing on reflux, whereas the results of sleeping place could also be extra refined or influenced by behavioral variability and self-reported measures.

These findings are per the notion that dietary patterns play a broader function in shaping GERD threat.

4.5. The Combined PRO–ANTI Score and Nutritional Coherence of the Findings

Although the PRO–ANTI rating was not considerably related to GERD in univariate evaluation, examination of the mixed PRO–ANTI rating revealed a directional development towards the next prevalence of GERD amongst members with a predominantly pro-inflammatory dietary profile. In the choice multivariable mannequin, this class was related to a considerably elevated threat of GERD, suggesting that international dietary imbalance turns into related after adjustment for behavioral and demographic components. This strategy is aligned with research through which international dietary indices had been employed to evaluate the influence of eating regimen on inflammatory situations [11,24].

These findings help the speculation that an total dietary imbalance could also be extra related than the remoted consumption of particular person “healthy” or “unhealthy” meals. In this context, dietary interventions might purpose to reconfigure the general dietary sample moderately than focusing solely on the elimination of meals perceived as “triggers” in isolation.

4.6. Clinical and Nutritional Implications

Our findings point out the prudence of integrating international dietary sample evaluation into GERD administration, as proposed in fashionable approaches to treating the situation [18,21,26].

This perspective is per medical guideline suggestions, which emphasize the multifactorial nature of GERD and the significance of contemplating behavioral and lifestyle-related components in symptom administration [9].

Future dietary interventions might concentrate on lowering total dietary inflammatory load and optimizing meal timing moderately than concentrating on particular person meals in isolation [23,26].

The lack of an unbiased affiliation between BMI and GERD means that the connection between extra physique weight and reflux could also be partially mediated by dietary and way of life behaviors. This statement is supported by population-based and interventional research indicating that behavioral modifications might enhance signs even independently of weight reduction [23].

From a public well being perspective, these outcomes spotlight the significance of easy dietary and behavioral interventions—akin to optimizing dietary patterns and avoiding late meals—as probably related methods for lowering the burden of gastroesophageal reflux signs within the grownup inhabitants. Future research incorporating longitudinal designs, interplay analyses, and extra complete multivariable fashions might foster a deeper understanding of causal relationships.