Associations Between Muscular Strength and Gastroesophageal Reflux Disease in Older Adults

in Journal of Physical Activity and Health
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Background: The association between muscular strength (MS) and prevalent gastroesophageal reflux disease (GERD) in the older adults is not well established. Methods: This study included 542 older adults with no history of myocardial infarction, stroke, or cancer. MS was measured by handgrip dynamometry. Participants were categorized into sex-specific quartiles of MS, while cases of GERD were identified by self-reported physician diagnosis. Logistic regression was used to calculate the odds ratios and 95% confidence intervals of GERD by quartiles of MS. Results: There were 112 GERD cases. Compared with the first quartile of MS, the odds ratios (95% confidence intervals) of GERD were 0.50 (0.27–0.95), 0.39 (0.20–0.75), and 0.55 (0.29–1.04) in the second, third, and fourth quartiles of MS, respectively, after adjusting for possible confounders including body mass index. In a joint analysis of MS and body mass index, participants were dichotomized into weak (first MS quartile) or strong (upper 3 MS quartiles) and normal weight, overweight, or obese. Compared with the weak–obese group, odds ratios (95% confidence intervals) were 0.34 (0.14–0.80), 0.43 (0.16–1.13), 0.29 (0.12–0.68), 0.18 (0.06–0.55), and 0.07 (0.03–0.21) for the strong–obese, weak–overweight, strong–overweight, weak–normal weight, and strong–normal weight. Conclusions: MS was independently and inversely associated with GERD in older adults.

The authors are with the Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, IA, USA.

Song (bksong@iastate.edu) is corresponding author.
  • 1.

    El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871880. PubMed ID: 23853213 doi:10.1136/gutjnl-2012-304269

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Greenwald DA. Aging, the gastrointestinal tract, and risk of acid-related disease. Am J Med. 2004;117(suppl 5A):8S13S.

  • 3.

    Dore MP, Maragkoudakis E, Fraley K, et al. Diet, lifestyle and gender in gastro-esophageal reflux disease. Dig Dis Sci. 2008;53(8):20272032. PubMed ID: 18030622 doi:10.1007/s10620-007-0108-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354(22):23402348.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Djärv T, Wikman A, Nordenstedt H, Johar A, Lagergren J, Lagergren P. Physical activity, obesity and gastroesophageal reflux disease in the general population. World J Gastroenterol. 2012;18(28):37103714. PubMed ID: 22851863 doi:10.3748/wjg.v18.i28.3710

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Graham DY. The changing epidemiology of GERD: geography and Helicobacter pylori. Am J Gastroenterol. 2003;98(7):14621470. PubMed ID: 12873564 doi:10.1111/j.1572-0241.2003.07533.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Pilotto A. Aging and upper gastrointestinal disorders. Best Pract Res Clin Gastroenterol. 2004;18(suppl):7381. doi:10.1016/j.bpg.2004.06.015

  • 8.

    Nam SY. Obesity-related digestive diseases and their pathophysiology. Gut Liver. 2017;11(3):323334. PubMed ID: 27890867 doi:10.5009/gnl15557

  • 9.

    Moses FM. The effect of exercise on the gastrointestinal tract. Sports Med. 1990;9(3):159172. PubMed ID: 2180030 doi:10.2165/00007256-199009030-00004

  • 10.

    Volaklis KA, Halle M, Meisinger C. Muscular strength as a strong predictor of mortality: a narrative review. Eur J Intern Med. 2015;26(5):303310. PubMed ID: 25921473 doi:10.1016/j.ejim.2015.04.013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):11431211. PubMed ID: 23798298

  • 12.

    Cheung CL, Nguyen US, Au E, Tan KC, Kung AW. Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study. Age. 2013;35(3):929941. doi:10.1007/s11357-012-9385-y

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):20202028. PubMed ID: 30418471 doi:10.1001/jama.2018.14854

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    El-Serag H. The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci. 2008;53(9):23072312. PubMed ID: 18651221 doi:10.1007/s10620-008-0413-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143(3):199211. PubMed ID: 16061918 doi:10.7326/0003-4819-143-3-200508020-00006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kim YM, Kim JH, Baik SJ, et al. Association between skeletal muscle attenuation and gastroesophageal reflux disease: a health check-up cohort study. Sci Rep. 2019;9(1):20102. PubMed ID: 31882910 doi:10.1038/s41598-019-56702-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Huang Y, Xu J, Yu B, Shull PB. Validity of FitBit, Jawbone UP, Nike+ and other wearable devices for level and stair walking. Gait Posture. 2016;48:3641. PubMed ID: 27477705 doi:10.1016/j.gaitpost.2016.04.025

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Saint-Maurice PF, Troiano RP, Bassett DR Jr, et al. Association of daily step count and step intensity with mortality among US adults. JAMA. 2020;323(12):11511160. PubMed ID: 32207799 doi:10.1001/jama.2020.1382

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of step volume and intensity with all-cause mortality in older women [published online ahead of print, 2019 May 29]. JAMA Intern Med. 2019;179(8):11051112. PubMed ID: 31141585 doi:10.1001/jamainternmed.2019.0899

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    World Health Organization (WHO). Global database on body mass index: BMI classification. Author. 2006;

  • 21.

    Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266273. PubMed ID: 25982160 doi:10.1016/S0140-6736(14)62000-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Vaz M, Thangam S, Prabhu A, Shetty PS. Maximal voluntary contraction as a functional indicator of adult chronic undernutrition. Br J Nutr. 1996;76(1):915. PubMed ID: 8774213 doi:10.1079/BJN19960005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    American Diabetes Association. (2) Classification and diagnosis of diabetes. Diabetes Care. 2015;38(suppl):S8S16.

  • 24.

    Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk [published correction appears in J Am Coll Cardiol. 2014 Oct 7;64(14):1537]. J Am Coll Cardiol. 2014;64(5):472481. PubMed ID: 25082581 doi:10.1016/j.jacc.2014.04.058

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Tudor-Locke C, Craig CL, Brown WJ, et al. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act. 2011;8(1):79. PubMed ID: 21798015 doi:10.1186/1479-5868-8-79

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Albin EE, Brellenthin AG, Lang JA, Meyer JD, Lee DC. Cardiorespiratory fitness and muscular strength on arterial stiffness in older adults. Med Sci Sports Exerc. 2020;52(8):17371744. PubMed ID: 32102053 doi:10.1249/MSS.0000000000002319

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014;311(23):23872396. PubMed ID: 24866862 doi:10.1001/jama.2014.5616

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Peel JB, Sui X, Matthews CE, et al. Cardiorespiratory fitness and digestive cancer mortality: findings from the aerobics center longitudinal study. Cancer Epidemiol Biomarkers Prev. 2009;18(4):11111117. PubMed ID: 19293313 doi:10.1158/1055-9965.EPI-08-0846

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA. 2007;298(21):25072516. PubMed ID: 18056904 doi:10.1001/jama.298.21.2507

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Artero EG, Lee DC, Ruiz JR, et al. A prospective study of muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 2011;57(18):18311837. PubMed ID: 21527158 doi:10.1016/j.jacc.2010.12.025

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337(7661):a439. doi:10.1136/bmj.a439

  • 32.

    Ho FKW, Celis-Morales CA, Petermann-Rocha F, et al. The association of grip strength with health outcomes does not differ if grip strength is used in absolute or relative terms: a prospective cohort study. Age Ageing. 2019;48(5):684691. PubMed ID: 31204772 doi:10.1093/ageing/afz068

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Prevalence of gastro-oesophageal reflux symptoms and the influence of age and sex. Scand J Gastroenterol. 2004;39(11):10401045. PubMed ID: 15545159 doi:10.1080/00365520410003498

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):12431250. PubMed ID: 15929752 doi:10.1111/j.1572-0241.2005.41703.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Rubenstein JH, Chen JW. Epidemiology of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2014;43(1):114. PubMed ID: 24503355 doi:10.1016/j.gtc.2013.11.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Kim TN, Park MS, Ryu JY, et al. Impact of visceral fat on skeletal muscle mass and vice versa in a prospective cohort study: the Korean Sarcopenic Obesity Study (KSOS). PLoS One. 2014;9(12):e115407. PubMed ID: 25517117 doi:10.1371/journal.pone.0115407

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Nam SY, Choi IJ, Ryu KH, et al. The effect of abdominal visceral fat, circulating inflammatory cytokines, and leptin levels on reflux esophagitis. J Neurogastroenterol Motil. 2015;21(2):247254. PubMed ID: 25843077 doi:10.5056/jnm14114

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut. 2004;53(12):17301735. PubMed ID: 15542505 doi:10.1136/gut.2004.043265

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Lee J, Anggiansah A, Anggiansah R, Young A, Wong T, Fox M. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterol Hepatol. 2007;5(12):13921398. PubMed ID: 17936081 doi:10.1016/j.cgh.2007.08.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Dumic I, Nordin T, Jecmenica M, Stojkovic Lalosevic M, Milosavljevic T, Milovanovic T. Gastrointestinal tract disorders in older age. Can J Gastroenterol Hepatol. 2019;2019:1. PubMed ID: 30792972 doi:10.1155/2019/6757524

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA. 2003;290(1):6672. PubMed ID: 12837713 doi:10.1001/jama.290.1.66

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Britton E, McLaughlin JT. Ageing and the gut. Proc Nutr Soc. 2013;72(1):173177. PubMed ID: 23146206 doi:10.1017/S0029665112002807

  • 43.

    Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(11):26192628. PubMed ID: 16952280 doi:10.1111/j.1572-0241.2006.00849.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Chang P, Friedenberg F. Obesity and GERD. Gastroenterol Clin North Am. 2014;43(1):161173. PubMed ID: 24503366 doi:10.1016/j.gtc.2013.11.009

  • 45.

    Celis-Morales CA, Welsh P, Lyall DM, et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651. PubMed ID: 29739772

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Mehta RS, Nguyen LH, Ma W, Staller K, Song M, Chan AT. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women [published online ahead of print, 2021 Jan 4]. JAMA Intern Med. 2021;10:1001

    • Search Google Scholar
    • Export Citation
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