Objective: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders (FGIDs), there is no epidemiological data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia (FD), its symptoms, and gastroesophageal reflux disease (GERD) in a large group of Iranian adults. Design, Setting, and Subjects: In a cross-sectional study on 3,363 Iranian adults, we calculated the “healthy lifestyle score” for each participant by summing up the binary score given for 5 lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking, and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire, and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. To assess FGIDs, a validated Persian version of ROME III questionnaire was used. Results: After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD (OR: 0.21; 95% CI: 0.05–0.92) and GERD (OR: 0.26; 95% CI: 0.09–0.69), respectively, compared with those with the lowest score. They were also less likely to have early satiation (OR: 0.28; 95% CI: 0.11–0.73), postprandial fullness (OR: 0.22; 95% CI: 0.09–0.50), and epigastric pain (OR: 0.44; 95% CI: 0.21–0.92). In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits, and nonsmoking were separately and protectively associated with FGIDs. Conclusion: We found that adherence to a healthy lifestyle was associated with lower odds of GERD, FD, and its symptoms in this group of Iranian adults, in a dose-response manner. Individual lifestyle-related factors were also associated with these conditions.

1.
Camilleri
M
,
Dubois
D
,
Coulie
B
,
Jones
M
,
Kahrilas
PJ
,
Rentz
AM
, et al
Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study
.
Clin Gastroenterol Hepatol
.
2005
;
3
:
543
52
.
2.
Sobieraj
DM
,
Coleman
SM
,
Coleman
CI
.
US prevalence of upper gastrointestinal symptoms: a systematic literature review
.
Am J Manag Care
.
2011
;
17
:
e449
458
.
3.
El-Serag
HB
,
Sweet
S
,
Winchester
CC
,
Dent
J
.
Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review
.
Gut
.
2014
;
63
:
871
80
.
4.
Lacy
BE
,
Talley
NJ
,
Locke
GR
 III
,
Bouras
EP
,
DiBaise
JK
,
El-Serag
HB
, et al
Review article: current treatment options and management of functional dyspepsia
.
Aliment Pharmacol Ther
.
2012
;
36
:
3
15
.
5.
Eslick
GD
.
Gastrointestinal symptoms and obesity: a meta-analysis
.
Obes Rev
.
2012
;
13
:
469
79
.
6.
Nandurkar
S
,
Locke
GR
 III
,
Fett
S
,
Zinsmeister
AR
,
Cameron
AJ
,
Talley
NJ
.
Relationship between body mass index, diet, exercise and gastro-oesophageal reflux symptoms in a community
.
Aliment Pharmacol Ther
.
2004
;
20
:
497
505
.
7.
Ruhl
CE
,
Everhart
JE
.
Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey
.
Ann Epidemiol
.
1999
;
9
:
424
35
.
8.
Jarosz
M
,
Taraszewska
A
.
Risk factors for gastroesophageal reflux disease: the role of diet
.
Prz Gastroenterol
.
2014
;
9
:
297
301
.
9.
Feinle-Bisset
C
,
Horowitz
M
.
Dietary factors in functional dyspepsia
.
Neurogastroenterol Motil
.
2006
;
18
:
608
18
.
10.
Yamamichi
N
,
Mochizuki
S
,
Asada-Hirayama
I
,
Mikami-Matsuda
R
,
Shimamoto
T
,
Konno-Shimizu
M
, et al
Lifestyle factors affecting gastroesophageal reflux disease symptoms: a cross-sectional study of healthy 19864 adults using FSSG scores
.
BMC Med
.
2012
;
10
:
45
.
11.
Pehl
C
,
Pfeiffer
A
,
Wendl
B
,
Nagy
I
,
Kaess
H
.
Effect of smoking on the results of esophageal pH measurement in clinical routine
.
J Clin Gastroenterol
.
1997
;
25
:
503
6
.
12.
Song
JH
,
Chung
SJ
,
Lee
JH
,
Kim
YH
,
Chang
DK
,
Son
HJ
, et al
Relationship between gastroesophageal reflux symptoms and dietary factors in Korea
.
J Neurogastroenterol Motil
.
2011
;
17
:
54
60
.
13.
El-Serag
HB
,
Satia
JA
,
Rabeneck
L
.
Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers
.
Gut
.
2005
;
54
:
11
7
.
14.
Nilsson
M
,
Johnsen
R
,
Ye
W
,
Hveem
K
,
Lagergren
J
.
Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux
.
Gut
.
2004
;
53
:
1730
5
.
15.
Nocon
M
,
Labenz
J
,
Willich
SN
.
Lifestyle factors and symptoms of gastro-oesophageal reflux: a population-based study
.
Aliment Pharmacol Ther
.
2006
;
23
:
169
74
.
16.
Saito
YA
,
Locke
GR
 III
,
Weaver
AL
,
Zinsmeister
AR
,
Talley
NJ
.
Diet and functional gastrointestinal disorders: a population-based case-control study
.
Am J Gastroenterol
.
2005
;
100
:
2743
8
.
17.
Hongo
M
.
Epidemiology of FGID symptoms in Japanese general population with reference to life style
.
J Gastroenterol Hepatol
.
2011
;
26
(
Suppl 3
):
19
22
.
18.
Festi
D
,
Scaioli
E
,
Baldi
F
,
Vestito
A
,
Pasqui
F
,
Di Biase
AR
, et al
Body weight, lifestyle, dietary habits and gastroesophageal reflux disease
.
World J Gastroenterol
.
2009
;
15
:
1690
701
.
19.
Van Oudenhove
L
,
Vandenberghe
J
,
Geeraerts
B
,
Vos
R
,
Persoons
P
,
Fischler
B
, et al
Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation?
Gut
.
2008
;
57
:
1666
73
.
20.
Adibi
P
,
Keshteli
AH
,
Esmaillzadeh
A
,
Afshar
H
,
Roohafza
H
,
Bagherian-Sararoudi
R
, et al
The study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN): overview of methodology
.
J Res Med Sci
.
2012
;
17
(
Spec 2
):
S292
S298
.
21.
Esmaillzadeh
A
,
Keshteli
AH
,
Feizi
A
,
Zaribaf
F
,
Feinle-Bisset
C
,
Adibi
P
.
Patterns of diet-related practices and prevalence of gastro-esophageal reflux disease
.
Neurogastroenterol Motil
.
2013
;
25
:
831
e638
.
22.
Keshteli
AH
,
Feizi
A
,
Esmaillzadeh
A
,
Zaribaf
F
,
Feinle-Bisset
C
,
Talley
NJ
, et al
Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia
.
Br J Nutr
.
2015
;
113
:
803
12
.
23.
Saneei
P
,
Esmaillzadeh
A
,
Keshteli
AH
,
Feizi
A
,
Feinle-Bisset
C
,
Adibi
P
.
Patterns of dietary habits in relation to obesity in Iranian adults
.
Eur J Nutr
.
2016
;
55
:
713
28
.
24.
Keshteli
A
,
Esmaillzadeh
A
,
Rajaie
S
,
Askari
G
,
Feinle-Bisset
C
,
Adibi
P
.
A Dish-based semi-quantitative food frequency questionnaire for assessment of dietary intakes in epidemiologic studies in Iran: design and development
.
Int J Prev Med
.
2014
;
5
:
29
36
.
25.
NICE
.
Promoting and creating built or natural environments that encourage and support physical activity: scope
.
London
:
National Institute for Health and Clinical Excellence
;
2006
.
26.
Montazeri
A
,
Harirchi
AM
,
Shariati
M
,
Garmaroudi
G
,
Ebadi
M
,
Fateh
A
.
The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version
.
Health Qual Life Outcomes
.
2003
;
1
:
66
.
27.
Esmaillzadeh
A
,
Azadbakht
L
.
Legume consumption is inversely associated with serum concentrations of adhesion molecules and inflammatory biomarkers among Iranian women
.
J Nutr
.
2012
;
142
:
334
9
.
28.
Sorouri
M
,
Pourhoseingholi
MA
,
Vahedi
M
,
Safaee
A
,
Moghimi-Dehkordi
B
,
Pourhoseingholi
A
, et al
Functional bowel disorders in Iranian population using Rome III criteria
.
Saudi J Gastroenterol
.
2010
;
16
:
154
60
.
29.
Zheng
Z
,
Nordenstedt
H
,
Pedersen
NL
,
Lagergren
J
,
Ye
W
.
Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins
.
Gastroenterology
.
2007
;
132
:
87
95
.
30.
Jiang
SM
,
Lei
XG
,
Jia
L
,
Xu
M
,
Wang
SB
,
Liu
J
, et al
Unhealthy dietary behavior in refractory functional dyspepsia: a multicenter prospective investigation in China
.
J Dig Dis
.
2014
;
15
:
654
9
.
31.
Stake-Nilsson
K
,
Hultcrantz
R
,
Unge
P
,
Wengstrom
Y
.
Changes in symptoms and lifestyle factors in patients seeking healthcare for gastrointestinal symptoms: an 18-year follow-up study
.
Eur J Gastroenterol Hepatol
.
2013
;
25
:
1470
7
.
32.
Emerenziani
S
,
Zhang
X
,
Blondeau
K
,
Silny
J
,
Tack
J
,
Janssens
J
, et al
Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux
.
Am J Gastroenterol
.
2005
;
100
:
1251
6
.
33.
Pandolfino
JE
,
Bianchi
LK
,
Lee
TJ
,
Hirano
I
,
Kahrilas
PJ
.
Esophagogastric junction morphology predicts susceptibility to exercise-induced reflux
.
Am J Gastroenterol
.
2004
;
99
:
1430
6
.
34.
Parmelee-Peters
K
,
Moeller
JL
.
Gastroesophageal reflux in athletes
.
Curr Sports Med Rep
.
2004
;
3
:
107
11
.
35.
Revicki
DA
,
Wood
M
,
Wiklund
I
,
Crawley
J
.
Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease
.
Qual Life Res
.
1998
;
7
:
75
83
.
36.
Klauser
AG
,
Schindlbeck
NE
,
Muller-Lissner
SA
.
Symptoms in gastro-oesophageal reflux disease
.
Lancet
.
1990
;
335
:
205
8
.
37.
Seyedmirzaei
SM
,
Haghdoost
AA
,
Afshari
M
,
Dehghani
A
.
Prevalence of dyspepsia and its associated factors among the adult population in southeast of Iran in 2010
.
Iran Red Crescent Med J
.
2014
;
16
:
e14757
.
38.
Mostaghni
A
,
Mehrabani
D
,
Khademolhosseini
F
,
Masoumi
SJ
,
Moradi
F
,
Zare
N
, et al
Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran
.
World J Gastroenterol
.
2009
;
15
:
961
5
.
39.
Chiuve
SE
,
Cook
NR
,
Shay
CM
,
Rexrode
KM
,
Albert
CM
,
Manson
JE
, et al
Lifestyle-based prediction model for the prevention of CVD: the Healthy Heart Score
.
J Am Heart Assoc
.
2014
;
3
:
e000954
.
40.
Schulze
MB
,
Hoffmann
K
,
Boeing
H
,
Linseisen
J
,
Rohrmann
S
,
Mohlig
M
, et al
An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes
.
Diabetes Care
.
2007
;
30
:
510
5
.
41.
van Dam
RM
,
Li
T
,
Spiegelman
D
,
Franco
OH
,
Hu
FB
.
Combined impact of lifestyle factors on mortality: prospective cohort study in US women
.
BMJ
.
2008
;
337
:
a1440
.
42.
Saneei
P
,
Esmaillzadeh
A
,
Keshteli
AH
,
Reza Roohafza
H
,
Afshar
H
,
Feizi
A
, et al
Combined healthy lifestyle is inversely associated with psychological disorders among adults
.
PLoS One
.
2016
;
11
:
e0146888
.
43.
Hajishafiee
M
,
Keshteli
AH
,
Saneei
P
,
Feinle-Bisset
C
,
Esmaillzadeh
A
,
Adibi
P
.
Healthy lifestyle score and irritable bowel syndrome: a cross-sectional study in adults
.
Neurogastroenterol Motil
.
2020 May
;
32
(
5
):
e13793
.
Epub 2020 Jan 7
.
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