Dietary patterns and gastroesophageal reflux disease in Sri Lanka: A regional food culture perspective

Table 2 Region-specific dietary factors associated with gastroesophageal reflux disease and their reported manifestations

Region	Region-specific dietary exposure(s)	Reported association(s)	Evidence source	Ref.
East Asia (Korea)	Noodles, spicy foods, greasy meals, sweets, alcohol, bread, carbonated beverages, and caffeinated drinks	Mostly associated with worsening reflux symptoms	Case-control study	[9]
East Asia (Korea)	Legumes, vegetables, fruits, fish, milk, and related foods	Associated with lower NERD risk; reflux esophagitis is more strongly related to BMI and total energy intake	Large cross-sectional study	[10]
East Asia (Japan)	Large dinners, eating before sleep, midnight snacks, skipping breakfast, and irregular eating	Associated with increased GERD or NERD symptoms	Mixed observational/review evidence	[25-28]
Mediterranean region	Mediterranean diet rich in olive oil, vegetables, fruits, and fish; contrasted with non-Mediterranean diets	The Mediterranean diet is associated with lower GERD risk, whereas non-Mediterranean diets are associated with higher risk	Population-based cross-sectional study	[11]
South Asia (India)	Spices or spicy seasonings, non-vegetarian diet, fried foods, carbonated drinks, tea, or coffee	Associated with GERD, with non-vegetarian intake appearing to be a relatively stable associated factor	Epidemiological study; expert consensus	[12,18]
South Asia (Sri Lanka)	Oily foods, bread, wheat, coffee, and acidic or vinegar-based foods	Significantly associated with GERD symptoms	Nationwide cross-sectional study	[14]
South Asia (Sri Lanka)	Bread, but not other wheat products	Some patients reported heartburn or reflux only after eating bread; this remains a relatively distinctive observation	Cross-sectional finding; mechanistic support	[14,20,21]

BMI: Body mass index; NERD: Non-erosive reflux disease; GERD: Gastroesophageal reflux disease.