Since the discovery of
To date, there is a scarcity of published literature on the impact of irregular meals on HP infection or gastritis. This study aims to determine whether a prolonged irregular meal pattern is associated with increased risk of gastritis and HP infection.
The study protocol was approved by the National Healthcare Group Domain Specific Review Board. Consent was obtained from participants before the survey was carried out.
The sample size was calculated based on a community survey of 113 people in Singapore prior to the commencement of this study, which showed 16% had irregular meals. Postulating that this prevalence would double in subjects with HP and gastritis, 120 subjects per group has a power of 80% and a 2-sided test of 5% to achieve a statistically significant result.
All subjects were of Chinese ethnic origin and aged 50 years and above, in order to minimize the confounding factors of age and race. A total of 323 subjects were divided into three groups according to HP and gastritis status. The HP and gastritis group (Group A) consisted of patients diagnosed with HP and gastritis (
Recruitment process.
All subjects were administered a specially designed questionnaire by two trained dietitians. This included questions regarding regularity of meals, the frequency and duration of any changes to usual meal timing, variation in the amount of food eaten, and the practice of skipping meals. Subjects in Groups A and B were surveyed regarding their eating patterns prior to the diagnosis of HP or gastritis. Subjects in the control group (Group C) were asked to respond regarding their eating pattern prior to endoscopy, or prior to interview for the community recruited subjects.
We defined irregular meals as a deviation from regular meal timing for 1 hour or more at least once per week. Questions regarding the practice of skipping meals were worded to detect subjects who omitted non-corresponding meals of the day (i.e., not the same meal every day). Subjects who missed the same meal each day were considered to have a regular meal pattern consisting of one less meal per day. The questionnaire also surveyed probiotic consumption, the presence of stress or any major stressful event prior to diagnosis, to enable these to be addressed as confounders.
All analyses were performed using SPSS 17.0 with statistical significance set at
Table
Demographics of study subjects.
HP + Gastritis (Group A) |
Gastritis (Group B) |
Control (Group C) |
| |
---|---|---|---|---|
Age (year) | 0.239 | |||
Mean ± SD | 62.5 ± 7.3 | 63.1 ± 7.5 | 61.0 ± 7.0 | |
Range | 51–79 | 52–87 | 50–82 | |
Gender | 0.163 | |||
Male | 71 (58.7%) | 51 (51.0%) | 47 (46.1%) | |
Female | 50 (41.3%) | 49 (49.0%) | 55 (53.9%) |
HP:
Table
Relationship between deviation from regular meals by number of hours and
Deviation from regular meals | Control |
HP |
Gastritis |
Group A versus Control: |
Group B versus Control: | ||
---|---|---|---|---|---|---|---|
Unadjusted | Adjusted# | Unadjusted | Adjusted# | ||||
0 to <1 hour | 62 (60.8%) | 38 (31.4%) | 28 (28%) | OR = 1.0 | OR = 1.0 | OR = 1.0 | OR = 1.0 |
≥1 to <1.5 hours | 26 (25.5%) | 24 (19.83%) | 33 (33%) | OR = 1.5 |
OR = 1.5 |
OR = 2.8 |
OR = 2.5 |
≥1.5 to <2 hours | 5 (4.9%) | 11 (9.09%) | 8 (8%) | OR = 3.6 |
OR = 4.2 |
OR = 3.5 |
OR = 3.3 |
≥2 hours | 9 (8.8%) | 48 (39.67%) | 31 (31%) | OR = 8.7 |
OR = 13.3 |
OR = 7.6 |
OR = 6.1 |
HP:
#Adjusted for gender, age, stress, and use of probiotics.
*Statistical significance.
Note: there were no statistical differences in the frequency of deviation from regular meals between groups A and B.
Relationship between deviation from regular meals by frequency per week and
Frequency of meal deviation per week | Control |
HP |
Gastritis |
Group A versus Control: |
Group B versus Control: | ||
---|---|---|---|---|---|---|---|
Unadjusted | Adjusted | Unadjusted | Adjusted | ||||
0 | 62 (60.8%) | 38 (31.4%) | 28 (28%) | OR = 1.0 | OR = 1.0 | OR = 1.0 | OR = 1.0 |
1 | 15 (14.7%) | 25 (20.66%) | 21 (21%) | OR = 2.7 |
OR = 2.9 |
OR = 3.1 |
OR = 2.7 |
≥2 | 25 (24.51%) | 58 (47.93%) | 51 (51%) | OR = 3.8 |
OR = 4.4 |
OR = 4.52 |
OR = 3.8 |
HP:
#Adjusted for gender, age, stress, and use of probiotics.
*Statistical significance.
Note: there were no statistical differences in frequency of meal deviation between groups A and B.
Table
Distribution and odds ratio for subjects who deviate from regular meals stratified by hours and frequency of meal deviation.
Subjects who deviated from their regular meals by ≥1 hour for ≥2 times per week | Subjects who deviated from their regular meals by ≥2 hours for ≥2 times per week | |||||
---|---|---|---|---|---|---|
Count (%) | Unadjusted |
Adjusted# |
Count (%) | Unadjusted |
Adjusted# |
|
Control ( |
25 (24.5%) | OR = 1 | OR = 1.0 | 8 (7.8%) | OR = 1 | OR = 1.0 |
HP |
58 (47.9%) | OR = 2.8 |
OR = 3.1 |
34 (28%) | OR = 4.6 |
OR = 6.3 |
Gastritis (Group B) |
51 (51%) | OR = 3.2 |
OR = 2.9 |
26 (26%) | OR = 4.1 |
OR = 3.5 |
HP:
#Adjusted for gender, age, stress, and use of probiotics.
*Statistical significance.
Note: there were no statistical differences in frequency of meal deviation between groups A and B.
Mean period of meal deviation habit for
Mean ± SD (years) | 95% Confidence Interval for Mean | Difference between groups | |
---|---|---|---|
Control |
4.5 ± 6.7 | 3.2–5.8 |
|
HP + Gastritis (Group A) |
7.9 ± 7.1 | 6.6–9.1 | |
Gastritis (Group B) |
8.1 ± 7.2 | 6.7–9.6 | |
Total ( |
6.9 ± 7.2 | 6.1–7.7 |
HP:
*Statistical significance.
Although the proportion of subjects who skipped meals almost doubled in the HP with gastritis and gastritis groups in comparison to those in the control group (19% versus 9.8%), there was no significant difference between the groups (Table
Distribution and odds ratio for subjects who regularly skipped meals.
Omitted meal at least one time per week |
Unadjusted |
Adjusted# | |
---|---|---|---|
Control |
10 (9.8%) | OR = 1 | OR = 1 |
HP + Gastritis |
23 (19%) | OR = 2.2 |
OR = 2.3 |
Gastritis |
19 (19%) | OR = 2.2 |
OR = 2.2 |
HP:
#Adjusted for gender, age, stress, and use of probiotics.
Note: there were no statistical differences in frequency of skipped meals between groups A and B.
There was no significant difference between groups for subjects who had an inconsistent amount of food at each meal (Table
Distribution and odds ratio for subjects who had an inconsistent amount of food for each meal.
Inconsistent amount of food in corresponding meals |
Unadjusted |
Adjusted# | |
---|---|---|---|
Control |
9 (8.8%) | OR = 1 | OR = 1.0 |
HP |
18 (14.9%) | OR = 1.8 |
OR = 1.8 |
Gastritis |
20 (20%) | OR = 2.6 |
OR = 2.1 |
HP:
#Adjusted for gender, age, stress, and use of probiotics use.
*Statistical significance.
Note: there were no statistical differences in the frequency of inconsistent amount of food between groups A and B.
This study is the first to examine an association between the degree of irregularity in meal timing and risk of HP and gastritis. After controlling for the potential confounders of gender, age, stress, and consumption of probiotics, we found that deviating from regular meal timing by two hours or more was associated with a thirteenfold increase in risk of developing HP with gastritis, and a sixfold increase in risk of developing gastritis.
The association of dietary habits with the development of HP infection has been given relatively little attention. A number of studies have demonstrated evidence of an association between intake of specific food or nutrients and HP [
Bulgarian researchers who found an increase in radiologically documented gastroduodenal ulcers during a period of economic crisis reported their impression that skipped meals and chain smoking were contributory factors [
In this study, meal regularity and habits prior to the diagnosis of HP infection and gastritis were evaluated. The odds ratio increased as the deviation in meal timing increased in the case groups when compared to the control group. Not everyone who is exposed to HP will become infected [
The mean duration of meal timing deviation in this study was about 8 years for the case groups compared to 4.5 years in the control group. It has been suggested that to cause harm, HP must efficiently adapt to the gastric niche, a process that takes place over many years and involves regulation of bacterial genes in response to environmental factors [
It is well established that HP infection leads to gastritis [
The merits of this study are the fairly large sample size and the use of endoscopic biopsy as endpoint for diagnosis in three quarters of the study population. Due to ethical issues, endoscopic biopsies were not carried out on the community-recruited subjects in the control arm. However, comparison of participants with and without endoscopy results showed similar diet patterns and baseline characteristics (analyses not shown in this paper). Some subjects in the control group may have had HP without their knowledge, as individuals may remain asymptomatic despite having HP [
A major limitation of this study was the retrospective design and its inability to provide causal link of HP infections and gastritis to irregular eating patterns. Surveyor and respondent bias were further limitations in this retrospective study. Significant recall bias was possible with the self-reported questionnaires. An individual with chronic gastritis or HP infection might likely be much more aware of their dietary habits than a healthy control. In addition, the dietitians administering the questionnaire were not blinded to the participants’ diagnosis. lt
In conclusion, a variation in meal timing over a prolonged period appears to be associated with increased risk of symptomatic HP infection and gastritis. Regular timing of meals may play an important role in the prevention of these two medical conditions. As there is a scarcity of published data studying an association between irregular meal timing and HP and gastritis, this pilot paper warrants future prospective studies to determine the effect of irregular meals on the development of gastritis and HP.
S. L. Lim conceptualized the research design, planned the study, participated in the data collection, and wrote the paper. C. Canavarro participated in the data collection and commented on the paper. M. H. Zaw was involved in the interpretation of results and revision of the paper. F. Zhu participated in the recruitment of the participants and commented on the paper. W. C. Loke provided significant advice and was involved in revision of the paper. Y. H. Chan analyzed and interpreted the results of the study. K. G. Yeoh provided significant advice, was involved in the research design, and commented on the paper.
The authors wish to thank the dietitians of the Dietetics Department, National University Hospital, Singapore, for their assistance with community-based data collection prior to the study.