Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 2998–3008 | Cite as

Relationship Between Meal Frequency and Gastroesophageal Reflux Disease (GERD) in Iranian Adults

  • Mehrbod Vakhshoori
  • Ammar Hassanzadeh Keshteli
  • Parvane SaneeiEmail author
  • Ahmad Esmaillzadeh
  • Peyman Adibi
Original Article



The association between frequency of meals and snacks and gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries.


We aimed to determine the relationship between meal and snack frequency with GERD symptoms in a large sample of Iranian adults.


In this cross-sectional study, 4669 individuals filled out a questionnaire about their number of meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks, and participants were categorized into four categories: < 3, 3–5, 6–7 and ≥ 8 meals/day. GERD was defined as having heartburn sometimes or more during the last 3 months. The severity of disease was assessed.


The prevalence of GERD in the study population was 23.7%. There was no significant association between meal or snack frequency and GERD symptoms in the whole population. However, after adjustment of all potential confounders, we found that women who consumed 1–2 or 3–5 snacks per day, compared with those who never had snacks, had a 41% (OR 0.59; 95% CI 0.42–0.84) and 51% (OR 0.49; 95% CI 0.32–0.75) reduced risk of having GERD, respectively. Women who consumed 6–7 or ≥ 8 snacks and meals per day had a 38% (OR 0.62; 95% CI 0.41–0.96) and 43% (OR 0.57; 95% CI 0.34–0.95) risk reduction for GERD compared with those who ate < 3 snacks and meals per day.


We found no significant association between meal frequency and GERD symptoms in the whole population. Gender-specific analysis revealed inverse associations between meal and snack frequency and GERD in Iranian women. Further prospective studies are required to confirm these associations.


Gastroesophageal reflux Meal frequency Snack frequency Feeding behavior 



Gastroesophageal reflux disease,




Study on the Epidemiology of Psychological, Alimentary Health and Nutrition


Functional gastrointestinal disorder


Lower esophageal sphincter


Food Frequency Questionnaire


General Practice Physical Activity Questionnaire


Odds ratio

95% CI

95% Confidence interval


United States


Isfahan University of Medical Sciences


Analysis of variance


Statistical Package for the Social Sciences



This study was extracted from an MD dissertation that was approved by Isfahan University of Medical Sciences (no. 292017). The financial support for this study comes from the Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. The Integrative Functional Gastroenterology Research Center had no role in the conception, design, data analysis and manuscript drafting. We thank all the staff of Isfahan University of Medical Sciences who kindly participated in our study and the staff of the Public Relations Unit and other authorities of IUMS for their excellent cooperation.

Compliance with ethical standards

Conflict of interest

None of the authors had any personal or financial conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mehrbod Vakhshoori
    • 1
  • Ammar Hassanzadeh Keshteli
    • 1
    • 2
  • Parvane Saneei
    • 3
    • 4
    Email author
  • Ahmad Esmaillzadeh
    • 5
    • 6
    • 7
  • Peyman Adibi
    • 8
  1. 1.Integrative Functional Gastroenterology Research Center, Students’ Research CommitteeIsfahan University of Medical SciencesIsfahanIran
  2. 2.Department of MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
  4. 4.Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
  5. 5.Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular–Cellular Sciences InstituteTehran University of Medical SciencesTehranIran
  6. 6.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  7. 7.Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  8. 8.Integrative Functional Gastroenterology Research CenterIsfahan University of Medical SciencesIsfahanIran

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