Predictive Factors for Future Onset of Reflux Esophagitis: A Longitudinal Case-control Study Using Health Checkup Records.

BACKGROUND/AIMS: Although risk factors of reflux esophagitis (RE) have been investigated in numerous cross-sectional studies, little is known about predictive factors associated with future onset of RE. We investigated time courses of clinical parameters before RE onset by a longitudinal case-control study using health checkup records. METHODS: We used health checkup records between April 2004 and March 2014 at 9 institutions in Japan. A multivariate logistic regression analysis was performed to evaluate associations of baseline clinical parameters with RE. The time courses of the clinical parameters of RE subjects were compared with those of non-RE subjects by the mixed-effects models for repeated measures analysis or longitudinal multivariate logistic analysis. RESULTS: Initial data were obtained from 230 056 individuals, and 2066 RE subjects and 4132 non-RE subjects were finally included in the analysis. Body mass index, alanine aminotransferase, smoking, acid reflux symptoms, hiatal hernia, and absence of atrophic gastritis at baseline were independently associated with RE. The time courses of body mass index, fasting blood sugar, triglyceride, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, percentages of acid reflux symptoms, feeling of fullness, and hiatal hernia in the RE group were significantly worse than in the non-RE group. CONCLUSIONS: The RE group displayed a greater worsening of the clinical parameters associated with lifestyle diseases, including obesity, diabetes, hyperlipidemia, and fatty liver for 5 years before RE onset compared with the non-RE group. These results suggest that RE is a lifestyle disease and thus lifestyle guidance to at-risk person may help to prevent RE onset.

Roles of alcohol consumption in fatty liver: a longitudinal study.

BACKGROUND & AIMS: Roles of alcohol consumption in non-alcoholic fatty liver disease are still controversial, although several cross-sectional studies have suggested the beneficial effect of light to moderate drinking on fatty liver. We analyzed the longitudinal relationship between drinking pattern and fatty liver. METHODS: We included 5297 Japanese individuals (3773 men and 1524 women) who underwent a baseline study in 2003 and follow-up at least once from 2004 to 2006. Generalized estimating equation was used to estimate any association between drinking pattern and fatty liver assessed by ultrasonography. RESULTS: At baseline, 1179 men (31.2%) and 235 women (15.4%) had fatty liver; 2802 men (74.2%) and 436 women (28.6%) reported alcohol consumption. At the latest follow-up, 348 of 2594 men (13.4%) and 101 of 1289 women (7.8%) had newly developed fatty liver; 285 of 1179 men (24.2%) and 70 of 235 women (29.8%) demonstrated a remission of fatty liver. In men, drinking 0.1-69.9 g/week (odds ratio, 0.79 [95% confidence interval, 0.68-0.90]), drinking 70.0-139.9 g/week (0.73 [0.63-0.84]), drinking 140.0-279.9 g/week (0.69 [0.60-0.79]), and drinking ⩾280.0 g/week (0.68 [0.58-0.79]) were inversely associated with fatty liver after adjusting for obesity, exercise, and smoking. In women, drinking 0.1-69.9 g/week (0.71 [0.52-0.96]) and drinking 70.0-139.9 g/week (0.67 [0.45-0.98]) were inversely associated with fatty liver after the adjustment. CONCLUSIONS: Light to moderate alcohol consumption, or even somewhat excessive amounts especially in men, was likely to protect most individuals against fatty liver over time.

Roles of alcohol drinking pattern in fatty liver in Japanese women.

PURPOSE: Several studies have reported an inverse association between moderate alcohol consumption and prevalence of fatty liver (FL) in men. We aimed to clarify this association in women. METHODS: We collected health checkup data from 4,921 Japanese women without concurrent liver disease (mean age 46.4 years) and performed a cross-sectional study to evaluate the influence of alcohol drinking patterns (frequency and amount) on the prevalence of FL as assessed by ultrasonography. RESULTS: Alcohol consumption was reported in 30.8 % of participants, and FL was observed in 13.8 % (15.5 % nondrinkers, 10.1 % drinkers). Alcohol consumption was inversely associated with FL prevalence [adjusted odds ratio (AOR) 0.79, 95 % confidence interval (CI) 0.63-0.98]. In analyses stratified by drinking frequency and/or amount of alcohol consumed, the risk of FL decreased for the following categories: 0.1-19.9 g/drinking day (AOR 0.61, 95 % CI 0.44-0.83) and 0.1-69.9 g/week (AOR 0.74, 95 % CI 0.55-0.98). The amount of alcohol consumed directly correlated with the prevalence of FL in daily drinkers (p < 0.05), whereas there was no correlation between the frequency of alcohol consumption and FL prevalence. Alanine aminotransferase levels were significantly lower for the following categories: 0.1-19.9 g/drinking day for 1-3 days a week (p = 0.016) and 0.1-69.9 g within 1-3 drinking days a week (p = 0.004). CONCLUSIONS: Minimal alcohol consumption appears to have protective effects against nonalcoholic FL disease in women, although an increase in the amount of alcohol consumed appears to nullify the protective effect.