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Obesity is a major public health problem that is associated with comorbidities, as reported by Brawer and colleagues in the September 2009 issue of Primary Care. Gastrointestinal (GI) tract symptoms are common in the general population, as noted by Eslick in the March 2010 issue of Gastroenterology Clinics of North America, but the association between GI symptoms and obesity is not clear.
This meta-analysis by Eslick evaluates which GI symptoms are or are not associated with increasing body mass index (BMI) or obesity in adults.
A new meta-analysis of studies found a significant association between specific GI symptoms and increasing BMI and obesity, with upper abdominal pain almost 3 times more likely to occur among obese individuals. These findings were published in the May issue of Obesity Reviews.
The final analysis included information from 21 studies comprising data from 77,538 individuals and found significant associations between the following symptoms and increasing BMI:
The study author, Guy D. Eslick, PhD, from the Whiteley-Martin Research Centre, the University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia, found no significant association with lower abdominal pain, bloating, constipation/hard stools, fecal incontinence, nausea, and anal blockage.
Dr. Eslick examined the variation in GI symptoms due to such factors as patient age, study year, percentage of male participants, response rate, and sample size by using meta-regression analysis. "The only statistically significant results were for those patients with acid regurgitation and included age (P< 0.0001), year of publication (P = 0.04), percent male (<0.0001), response rate (<0.0001) and sample size (<0.0001)," writes Dr. Eslick. This symptom appeared to decrease with age, but the risk for acid regurgitation increased among more recent studies. The author notes that this may be related to the increasing incidence of obesity.
Using a prospectively developed protocol, Dr. Eslick searched the major electronic databases (PubMed, MEDLINE, EMBASE, and Current Contents [1950 to November 2011]) using the keywords GI, symptoms, obesity, and overweight. The studies evaluated in the analysis included only adults (men and women); had a cross-sectional, case-control, or cohort design; were population- or patient-based; included any GI symptoms or complex of symptoms; and were published in any language.
Studies in which patients were part of a weight loss program, those not providing data that could be recalculated into ORs and CIs, and those that did not meet the previously established inclusion criteria were excluded from the evaluation.
The risk as determined by OR or relative risk was used to compare the BMI groups for each study reviewed, and each BMI group was compared for each GI symptom.
Why Is Obesity Linked to GI Symptoms?
Dr. Eslick discussed possible explanations for some of the GI symptoms in this population. For example, upper abdominal pain in these patients may be related to postprandial stomach distention or delayed gastric emptying, and diarrhea may be related to increased food intake leading to increased osmotic loads and poor stool consistency. Patients with gastroesophageal reflux disease may also have confounding factors, such as hiatal hernia, and require further endoscopic evaluation.
A strength of the analysis, notes Dr. Eslick, is the large number of patients evaluated in these studies. This provided the statistical power necessary to detect differences among BMI groups. He also acknowledges study limitations, such as the heterogeneity among studies of gastroesophageal reflux disease and missing data on mean age and percentage of male participants from some studies.
Noting that further research in this area is still required, Dr. Eslick concluded, "The findings in this meta-analysis could have implications for clinical practice, especially in regard to future guideline development for the management and understanding of GI disorders among obese individuals."
Dr. Eslick is supported by the International Union Against Cancer and the American Cancer Society with an International Fellowship for Beginning Investigators. Dr. Eslick has disclosed no relevant financial relationships.
Obes Rev. 2012;13:469-479. Abstract
