Association of Obesity with Coronary Artery Disease, Erosive Esophagitis and Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis
Abstract
Background: We aimed to determine the plausible role of high body mass index (BMI) in the etiopathogenesis of coronary artery disease (CAD), erosive esophagitis (EE) and gastroesophageal reflux disease (GERD) and their complex associations.
Methods: The published literature was retrieved from Cochrane, Google Scholar, Embase, PubMed and Scopus databases until August 2021 based on the inclusion and exclusion criteria. The Newcastle-Ottawa quality assessment scale was used for the risk of bias and publication bias with a funnel plot. Heterogeneity between studies underwent evaluation using the I2 statistic and Q-test, and a random and fixed-effect model analysed studies with low to moderate heterogeneity.
Results: Out of 3819 studies extracted, 20 studies were studied based on the inclusion and exclusion criteria. The study corroborated the direct association of GERD symptoms and EE among obese Odds Ratio (OR) = 4.25) and overweight subjects (OR 9.75). Separate analyses of the link between GERD symptoms and EE was conducted among the overweight (OR 4.11, OR 4.61) and obesity subjects was statistically significant (OR 12.07, OR 9.95). The corresponding adjusted OR was noted for the association of CAD with overweight and obesity amounted to 3.41 and 3.01, respectively. Separate subgroup analysis was analyzed based on different ethnic populations for the association between GERD symptoms and EE in obesity (OR of 9.38) and overweight (OR of 4.21) subjects were statistically significant (P<0.05). For population subgroup analyses the overall OR of 3.32 was noted on the association between CAD and obesity.
Conclusion: Moderate to severe BMI has bene considered as an independent risk factor for GERD symptoms, EE and CAD.
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3. GBD 2019 Risk Factors Collaborators (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet, 396:1223–49.
4. Lee WC, Wu PY, Huang JC, et al (2022). Sex Difference in the Associations among Obesity-Related Indices with Incident Hypertension in a Large Taiwanese Population Follow-Up Study. J Pers Med, 15:972.
5. Peters A, Hartwig M, Spiller T (2022). Obesi-ty and Type 2 Diabetes Mellitus Ex-plained by the Free Energy Principle. Front Psychol, 10:931701.
6. Jiang K, Chen B, Lou D, et al (2022). Sys-tematic review and meta-analysis: associa-tion between obesity/overweight and surgical complications in IBD. Int J Colo-rectal Dis, 31.
7. Eisa M, Sandhu A, Prakash R, Ganocy SJ, Fass R (2020). The Risk of Acute Myo-cardial Infarction in Patients with Gas-troesophageal Reflux Disease. J Neurogas-troenterol Motil. 30:471-76.
8. Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ (2015). Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore. PLoS ONE, 10: e0122985.
9. Prasad DS, Kabir Z, Dash AK, Das BC (2012). Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. J Cardiovasc Dis Res, 3: 204-11.
10. Song JH, Kim YS, Choi SY, Yang SY (2022). Association between gas-troesophageal reflux disease and coro-nary atherosclerosis. PLoS One, 20:e0267053.
11. Gandhi S, Narula N, Marshall JK, Farkouh M (2012). Are patients with inflammatory bowel disease at increased risk of coro-nary artery disease? Am J Med, 125: 956-62.
12. Scarpa M, Ruffolo C, Erroi F, et al (2014). Obesity is a Risk Factor for Multifocal Disease and Recurrence after Colorectal Cancer Surgery: A Case-Control Study. Anticancer Res,; 34:5735-41.
13. Vaishnav B, Bamanikar A, Maske P, Reddy A, Dasgupta S (2017). Gastroesophageal reflux disease and its association with body mass index: clinical and endoscopic study. J Clin Diagnostic Res, 11: OC01.
14. Min YW, Song BG, Kim HS, et al (2017). Associations between reflux esophagitis and the progression of coronary artery calcification: A cohort study. PLoS One, 12: e0184996.
15. Hampel H, Abraham NS, El-Serag HB (2005). Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med,143: 199–11.
16. Liu Y, He S, Chen Y, et al (2013). Acid re-flux in patients with coronary artery dis-ease and refractory chest pain. Intern Med, 52: 1165–1171.
17. Xu Z, Jiang W, Huang W, Lin Y, Chan FK, Ng SC (2022). Gut microbiota in patients with obesity and metabolic disorders—a systematic review. Genes & Nutrition, 17:1-8.
18. El-Serag HB, Sweet S, Winchester CC, Dent J (2014). Update on the epidemiology of gastro-oesophageal reflux disease: a sys-tematic review. Gut, 63:871–880. .
19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA state-ment. BMJ, 339: 2535.
20. Kang MS, Park DI, Oh SY, et al (2007). Ab-dominal obesity is an independent risk factor for erosive esophagitis in a Korean population. J Gastroenterol Hepatol, 22: 1656-61.
21. Chung SJ, Kim D, Park MJ, et al (2008). Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut, 57: 1360-65.
22. Chua CS, Lin YM, Yu FC, et al (2009). Met-abolic risk factors associated with erosive esophagitis. J Gastroenterol Hepatol, 24: 1375-79.
23. Lee H, Eun C, Lee O, et al (2008). Associa-tion between Erosive Esophagitis and Visceral Fat Accumulation Quantified by Abdominal CT Scan. J Clin Gastroenterol, 43: 240-43.
24. Nam SY, Choi IJ, Ryu KH, Park BJ, Kim HB et al (2010). Abdominal visceral adi-pose tissue volume is associated with in-creased risk of erosive esophagitis in men and women. Gastroenterology, 139: 1902-1911.e2.
25. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR, Rodriguez-Artalejo F (2004). Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish popula-tion. Aliment Pharmacol Ther, 19: 95-105.
26. Hung WC, Wu JS, Yang YC, Sun ZJ, Lu FH et al (2014). Nonalcoholic fatty liver dis-ease vs. obesity on the risk of erosive oe-sophagitis. Eur J Clin Invest, 44: 1143-1149.
27. Moki F, Kusano M, Mizuide M, et al (2007). Association between reflux oesophagitis and features of the metabolic syndrome in Japan. Aliment Pharmacol Ther, 26: 1069-75.
28. Nam SY, Choi IJ, Nam BH, Park KW, Kim CG (2009). Obesity and weight gain as risk factors for erosive oesophagitis in men. Aliment Pharmacol Ther, 29: 1042-52.
29. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J (2003). Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA-J Am Med Assoc, 290: 66-72.
30. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ (1999). Risk factors asso-ciated with symptoms of gastroesopha-geal reflux. Am J Med, 106: 642-49.
31. Choi S, Kim K, Kim SM, et al (2018). Asso-ciation of obesity or weight change with coronary heart disease among young adults in South Korea. JAMA Internal Med, 178: 1060-68.
32. Azab M, Al-Shudifat AE, Johannessen A, Al-Shdaifat A, Agraib LM et al (2018). Are Risk Factors for Coronary Artery Disease Different in Persons With and Without Obesity? Metab Syndr Relat Disord, 16: 440-45.
33. Bechlioulis A, Vakalis K, Naka KK, et al (2013). Paradoxical protective effect of central obesity in patients with suspected stable coronary artery disease. Obesity, 21: 314-21.
34. Tseng CH (2008). Waist-to-height ratio and CAD in Taiwanese type 2 diabetic pa-tients. Obesity, 16: 2754-59.
35. Lin GM, Li YH, Lai CP, Lin CL, Wang JH (2015). The obesity-mortality paradox in elderly patients with angiographic coro-nary artery disease: a report from the ET-CHD registry. Acta Cardiology, 70: 479-86.
36. Zen V, Fuchs FD, Wainstein MV et al (2012). Neck circumference and central obesity are independent predictors of coronary artery disease in patients under-going coronary angiography. Am J Cardi-ol, 2: 323-30.
37. Jensen JC, Dardari ZA, Blaha MJ, et al (2020). Association of Body Mass Index With Coronary Artery Calcium and Sub-sequent Cardiovascular Mortality: The Coronary Artery Calcium Consortium. Circ Cardiovasc Imaging, 13: e009495.
38. Hsu CH, Chang SGN, Hwang KC, Chou P (2007). Impact of obesity on coronary ar-tery calcification examined by electron beam computed tomographic scan. Dia-betes Obes Metab, 9: 354-59.
39. Park HW, Kim KH, Song IG, et al (2017). Body mass index, carotid plaque, and clinical outcomes in patients with coro-nary artery disease. Coron Artery Dis, 28: 278–86.
40. Sui Y, Zhao HL, Wong VCW et al (2012). A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. Obes Rev, 13: 409–30.
41. Corley DA, Kubo A (2006). Body mass in-dex and GERD: a systematic review and meta-analysis. Am J Gastroenterol, 101: 2619–28.
42. Baeg MK, Ko SH, Ko SY, Jung HS, Choi MG (2018). Obesity increases the risk of EE but metabolic unhealthiness alone does not: a large-scale cross-sectional study. BMC Gastroenterol, 18: 82.
43. Duggan JP, Peters AS, Trachiotis GD, An-tevil JL (2022). Epidemiology of Coro-nary Artery Disease. Surg Clin North Am, 102:499-16.
44. Jahangir E, De Schutter A, Lavie CJ (2014). The relationship between obesity and coronary artery disease. Transl Res, 164: 336-44.
45. Riaz H, Khan MS, Siddiqi TJ et al (2018). Association Between Obesity and Cardi-ovascular Outcomes: A Systematic Re-view and Meta-analysis of Mendelian Randomization Studies. JAMA Network Open, 1:e183788.
46. Coutinho T, Goel K, Corrêa de Sá D et al (2011). Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and col-laborative analysis with individual subject data. J Am Coll Cardiol, 57: 1877-86.
47. Reis JP, Loria CM, Lewis CE et al (2013). Association between Duration of Overall and Abdominal Obesity Beginning in Young Adulthood and Coronary Artery Calcification in Middle Age. JAMA, 310: 280-8.
48. Collaboration APCS (2007). The burden of overweight and obesity in the Asia–Pacific region. Obesity Rev, 8: 191-6.
49. Wu JCY (2008). Gastroesophageal reflux disease: an Asian perspective. J Gastroen-terol Hepato, 23: 1785-93.
2. Sørensen TI, Martinez AR, Jørgensen TS (2022). Epidemiology of Obesity. In: Handbook of Experimental Pharmacology. Springer, Berlin, Heidelberg; 1-25.
3. GBD 2019 Risk Factors Collaborators (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet, 396:1223–49.
4. Lee WC, Wu PY, Huang JC, et al (2022). Sex Difference in the Associations among Obesity-Related Indices with Incident Hypertension in a Large Taiwanese Population Follow-Up Study. J Pers Med, 15:972.
5. Peters A, Hartwig M, Spiller T (2022). Obesi-ty and Type 2 Diabetes Mellitus Ex-plained by the Free Energy Principle. Front Psychol, 10:931701.
6. Jiang K, Chen B, Lou D, et al (2022). Sys-tematic review and meta-analysis: associa-tion between obesity/overweight and surgical complications in IBD. Int J Colo-rectal Dis, 31.
7. Eisa M, Sandhu A, Prakash R, Ganocy SJ, Fass R (2020). The Risk of Acute Myo-cardial Infarction in Patients with Gas-troesophageal Reflux Disease. J Neurogas-troenterol Motil. 30:471-76.
8. Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ (2015). Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore. PLoS ONE, 10: e0122985.
9. Prasad DS, Kabir Z, Dash AK, Das BC (2012). Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from urban Eastern India. J Cardiovasc Dis Res, 3: 204-11.
10. Song JH, Kim YS, Choi SY, Yang SY (2022). Association between gas-troesophageal reflux disease and coro-nary atherosclerosis. PLoS One, 20:e0267053.
11. Gandhi S, Narula N, Marshall JK, Farkouh M (2012). Are patients with inflammatory bowel disease at increased risk of coro-nary artery disease? Am J Med, 125: 956-62.
12. Scarpa M, Ruffolo C, Erroi F, et al (2014). Obesity is a Risk Factor for Multifocal Disease and Recurrence after Colorectal Cancer Surgery: A Case-Control Study. Anticancer Res,; 34:5735-41.
13. Vaishnav B, Bamanikar A, Maske P, Reddy A, Dasgupta S (2017). Gastroesophageal reflux disease and its association with body mass index: clinical and endoscopic study. J Clin Diagnostic Res, 11: OC01.
14. Min YW, Song BG, Kim HS, et al (2017). Associations between reflux esophagitis and the progression of coronary artery calcification: A cohort study. PLoS One, 12: e0184996.
15. Hampel H, Abraham NS, El-Serag HB (2005). Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med,143: 199–11.
16. Liu Y, He S, Chen Y, et al (2013). Acid re-flux in patients with coronary artery dis-ease and refractory chest pain. Intern Med, 52: 1165–1171.
17. Xu Z, Jiang W, Huang W, Lin Y, Chan FK, Ng SC (2022). Gut microbiota in patients with obesity and metabolic disorders—a systematic review. Genes & Nutrition, 17:1-8.
18. El-Serag HB, Sweet S, Winchester CC, Dent J (2014). Update on the epidemiology of gastro-oesophageal reflux disease: a sys-tematic review. Gut, 63:871–880. .
19. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA state-ment. BMJ, 339: 2535.
20. Kang MS, Park DI, Oh SY, et al (2007). Ab-dominal obesity is an independent risk factor for erosive esophagitis in a Korean population. J Gastroenterol Hepatol, 22: 1656-61.
21. Chung SJ, Kim D, Park MJ, et al (2008). Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups. Gut, 57: 1360-65.
22. Chua CS, Lin YM, Yu FC, et al (2009). Met-abolic risk factors associated with erosive esophagitis. J Gastroenterol Hepatol, 24: 1375-79.
23. Lee H, Eun C, Lee O, et al (2008). Associa-tion between Erosive Esophagitis and Visceral Fat Accumulation Quantified by Abdominal CT Scan. J Clin Gastroenterol, 43: 240-43.
24. Nam SY, Choi IJ, Ryu KH, Park BJ, Kim HB et al (2010). Abdominal visceral adi-pose tissue volume is associated with in-creased risk of erosive esophagitis in men and women. Gastroenterology, 139: 1902-1911.e2.
25. Diaz-Rubio M, Moreno-Elola-Olaso C, Rey E, Locke GR, Rodriguez-Artalejo F (2004). Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish popula-tion. Aliment Pharmacol Ther, 19: 95-105.
26. Hung WC, Wu JS, Yang YC, Sun ZJ, Lu FH et al (2014). Nonalcoholic fatty liver dis-ease vs. obesity on the risk of erosive oe-sophagitis. Eur J Clin Invest, 44: 1143-1149.
27. Moki F, Kusano M, Mizuide M, et al (2007). Association between reflux oesophagitis and features of the metabolic syndrome in Japan. Aliment Pharmacol Ther, 26: 1069-75.
28. Nam SY, Choi IJ, Nam BH, Park KW, Kim CG (2009). Obesity and weight gain as risk factors for erosive oesophagitis in men. Aliment Pharmacol Ther, 29: 1042-52.
29. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J (2003). Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA-J Am Med Assoc, 290: 66-72.
30. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ (1999). Risk factors asso-ciated with symptoms of gastroesopha-geal reflux. Am J Med, 106: 642-49.
31. Choi S, Kim K, Kim SM, et al (2018). Asso-ciation of obesity or weight change with coronary heart disease among young adults in South Korea. JAMA Internal Med, 178: 1060-68.
32. Azab M, Al-Shudifat AE, Johannessen A, Al-Shdaifat A, Agraib LM et al (2018). Are Risk Factors for Coronary Artery Disease Different in Persons With and Without Obesity? Metab Syndr Relat Disord, 16: 440-45.
33. Bechlioulis A, Vakalis K, Naka KK, et al (2013). Paradoxical protective effect of central obesity in patients with suspected stable coronary artery disease. Obesity, 21: 314-21.
34. Tseng CH (2008). Waist-to-height ratio and CAD in Taiwanese type 2 diabetic pa-tients. Obesity, 16: 2754-59.
35. Lin GM, Li YH, Lai CP, Lin CL, Wang JH (2015). The obesity-mortality paradox in elderly patients with angiographic coro-nary artery disease: a report from the ET-CHD registry. Acta Cardiology, 70: 479-86.
36. Zen V, Fuchs FD, Wainstein MV et al (2012). Neck circumference and central obesity are independent predictors of coronary artery disease in patients under-going coronary angiography. Am J Cardi-ol, 2: 323-30.
37. Jensen JC, Dardari ZA, Blaha MJ, et al (2020). Association of Body Mass Index With Coronary Artery Calcium and Sub-sequent Cardiovascular Mortality: The Coronary Artery Calcium Consortium. Circ Cardiovasc Imaging, 13: e009495.
38. Hsu CH, Chang SGN, Hwang KC, Chou P (2007). Impact of obesity on coronary ar-tery calcification examined by electron beam computed tomographic scan. Dia-betes Obes Metab, 9: 354-59.
39. Park HW, Kim KH, Song IG, et al (2017). Body mass index, carotid plaque, and clinical outcomes in patients with coro-nary artery disease. Coron Artery Dis, 28: 278–86.
40. Sui Y, Zhao HL, Wong VCW et al (2012). A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. Obes Rev, 13: 409–30.
41. Corley DA, Kubo A (2006). Body mass in-dex and GERD: a systematic review and meta-analysis. Am J Gastroenterol, 101: 2619–28.
42. Baeg MK, Ko SH, Ko SY, Jung HS, Choi MG (2018). Obesity increases the risk of EE but metabolic unhealthiness alone does not: a large-scale cross-sectional study. BMC Gastroenterol, 18: 82.
43. Duggan JP, Peters AS, Trachiotis GD, An-tevil JL (2022). Epidemiology of Coro-nary Artery Disease. Surg Clin North Am, 102:499-16.
44. Jahangir E, De Schutter A, Lavie CJ (2014). The relationship between obesity and coronary artery disease. Transl Res, 164: 336-44.
45. Riaz H, Khan MS, Siddiqi TJ et al (2018). Association Between Obesity and Cardi-ovascular Outcomes: A Systematic Re-view and Meta-analysis of Mendelian Randomization Studies. JAMA Network Open, 1:e183788.
46. Coutinho T, Goel K, Corrêa de Sá D et al (2011). Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and col-laborative analysis with individual subject data. J Am Coll Cardiol, 57: 1877-86.
47. Reis JP, Loria CM, Lewis CE et al (2013). Association between Duration of Overall and Abdominal Obesity Beginning in Young Adulthood and Coronary Artery Calcification in Middle Age. JAMA, 310: 280-8.
48. Collaboration APCS (2007). The burden of overweight and obesity in the Asia–Pacific region. Obesity Rev, 8: 191-6.
49. Wu JCY (2008). Gastroesophageal reflux disease: an Asian perspective. J Gastroen-terol Hepato, 23: 1785-93.
| Files | ||
| Issue | Vol 51 No 8 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i8.10250 | |
| Keywords | ||
| Body mass index Obesity Acid reflux Coronary artery disease Overweight | ||
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How to Cite
1.
Li T, Cong L, Chen J, Deng H. Association of Obesity with Coronary Artery Disease, Erosive Esophagitis and Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(8):1690-1705.
