Pro- and Anti-Inflammatory Dietary Patterns and Lifestyle Factors Associated with Gastroesophageal Reflux Symptoms in...

Background: Gastroesophageal reflux disease (GERD) is a common digestive disorder with a substantial impact on quality of life. Emerging evidence suggests that dietary patterns and lifestyle behaviors are associated with the occurrence and severity of GERD symptoms; however, integrated data from Romania remain limited. Objective: The aim of this study was to evaluate associations between pro- and anti-inflammatory dietary patterns, lifestyle-related behavioral factors, and the presence and severity of gastroesophageal reflux symptoms in an adult Romanian population. Methods: A national cross-sectional observational study was conducted using a self-administered online questionnaire. All participants included in the study reported a prior diagnosis of gastroesophageal reflux disease (GERD), and participant classification was based exclusively on current symptomatology assessed using the GERD-Q score. Therefore, comparisons were not performed between patients and a healthy population, but rather between individuals at different stages of clinical expression of the same condition, characterized by a fluctuating course. The instrument included standardized GERD-Q items for symptom assessment, together with questions regarding dietary intake and lifestyle behaviors. Pro-inflammatory (PRO), anti-inflammatory (ANTI), and combined (PRO-ANTI) dietary scores were established. Statistical analyses included comparative and correlational tests as well as multivariable logistic regression models. Results: Among the 340 participants included in the study, 72.4% reported symptoms consistent with GERD according to the GERD-Q score. A higher pro-inflammatory dietary score was significantly associated with GERD, with participants in the highest PRO category showing more than a fourfold higher likelihood of GERD in multivariable analyses. Consumption of spicy foods and carbonated beverages was associated with an increased risk of GERD in univariate analyses; however, these associations did not remain significant in multivariable models. Late meals (defined as consumption of one's last meal of the day less than two hours before bedtime) were independently associated with GERD. Combined analyses indicated a higher risk among participants who reported eating late meals, particularly when combined with large evening meals. Most foods considered protective, along with classical lifestyle factors (smoking, alcohol consumption, and sleeping position), were not independently associated with GERD. Conclusions: These findings suggest that overall dietary patterns with pro-inflammatory potential and meal timing in relation to the sleep-wake cycle may be more consistently associated with GERD symptoms in this sample than isolated food items or traditional lifestyle risk factors. Nutritional and behavioral interventions focused on improving overall dietary patterns and avoiding late meals may represent potential strategies for GERD management.