Obesity is Associated With Increased Risk of Gastrointestinal Symptoms
10/24/04 07:42 PM
Loc: Seattle, WA
From The American Journal of Gastroenterology
Obesity is Associated With Increased Risk of Gastrointestinal Symptoms: A Population-Based Study
Silvia Delgado-Aros, M.D., Ph.D.; G. Richard Locke, III, M.D.; Michael Camilleri, M.D.; Nicholas J. Talley, M.D., Ph.D.; Sara Fett, B.S.; Alan R. Zinsmeister, Ph.D.; L. Joseph Melton, III, M.D
Abstract and Introduction
Objectives: Perception of sensations arising from the gastrointestinal tract may be diminished in obese subjects and thus facilitate overeating. Alternatively, excess food intake may cause gastrointestinal (GI) symptoms in obese patients. We evaluated the relationship between body mass index (BMI) and specific GI symptoms in the community.
Methods: Residents of Olmsted County, MN were selected at random to receive by mail one of two validated questionnaires. The association of reported GI symptoms with BMI (kg/m2) was assessed using a logistic regression analysis adjusting for age, gender, psychosomatic symptom score, and alcohol and tobacco use.
Results: Response rate was 74% (1,963 of 2,660). The prevalence of obesity (BMI >/= 30 kg/m2) was 23%. There was a positive relationship between BMI and frequent vomiting (p = 0.02), upper abdominal pain (p = 0.03), bloating (p = 0.002), and diarrhea (p = 0.01). The prevalence of frequent lower abdominal pain, nausea, and constipation was increased among obese (BMI >/= 30 kg/m2) compared to normal weight participants, however, no significant association was found between BMI and these symptoms.
Conclusions: In the community, increasing BMI is associated with increased upper GI symptoms, bloating, and diarrhea. Clarification of the cause-and-effect relationships and the mechanisms of these associations require further investigation.
Obesity has reached epidemic proportions. Data from the National Center for Health Statistics show that 64.5% of the U.S. population of age 20 or above is overweight (body mass index, BMI >/= 25 kg/m2), and 31% is clinically obese (BMI >/= 30 kg/m2). Obesity has a substantial impact on morbidity[2-8] and on the quality of life of these individuals, who have a poorer general health perception and daily functioning.[9,10] Obesity induces an enormous psychological burden.[11,12]
There are many factors involved in the development of obesity including environmental, psychological, and social factors as well as physiological mechanisms. Most of these mechanisms and their interactions are not fully understood.[13-16]
Dysregulation of the mechanisms that control food intake and energy expenditure is a key to the development of obesity. The gastrointestinal (GI) tract is a source of satiation factors, which contribute to meal termination, and hence determine meal size.[17-20] A decreased satiation response to food intake may play a role in the development of obesity.[21,22]
In contrast to the observation of decreased satiation in obese individuals, an increased prevalence of different GI symptoms has been reported in obese patients seeking treatment in a tertiary care center compared to community controls. However, obese patients seeking treatment may not be representative of obese individuals in the community.
We have previously reported that BMI is an independent risk factor for the presence of self-reported heartburn and regurgitation in a community-based population in the United States. Although BMI was not found to be associated with irritable bowel syndrome (IBS) in another study, the relationship between BMI and other GI symptoms has not previously been explored in the community.
If perception of satiation signals arising in the gut is reduced in obesity, one could entertain the hypothesis that perception of other sensations originated from the GI tract would be similarly reduced in obese individuals. An exception to this hypothesis would be the association between obesity and GERD symptoms, for which a mechanistic role (i.e., hiatal hernia) is assumed to be the cause of the symptoms. An alternative hypotheses is that excess food intake could lead to responses that increase GI symptoms.
In this study, we aimed to evaluate the relationship between BMI and specific GI symptoms, other than heartburn and regurgitation, in a community-based population.
Section 1 of 4 Next Page: Methods
Silvia Delgado-Aros, M.D., Ph.D., G. Richard Locke, III, M.D., Michael Camilleri, M.D., Nicholas J. Talley, M.D., Ph.D., Sara Fett, B.S., Alan R. Zinsmeister, Ph.D., and L. Joseph Melton, III, M.D, Clinical Enteric Neuroscience Translational & Epidemiological Research (C.E.N.T.E.R.) Program; and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
Am J Gastroenterol 99(9):1801-1806, 2004. © 2004 Blackwell Publishing
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