Adherence to healthy lifestyle behaviors was associated with a significantly lower risk of GERD in a dose-response manner, with the highest lifestyle score group showing a 37% reduced risk compared to those with the fewest healthy behaviors.
Key Findings
Results
A dose-response relationship was found between the number of healthy lifestyle behaviors and reduced GERD risk.
Relative to participants with less than 2 healthy lifestyle score points, those with scores of 2, 3, 4, and 5-7 showed HRs of 0.94 (95% CI: 0.90-0.98), 0.83 (0.80-0.86), 0.74 (0.71-0.77), and 0.63 (0.60-0.66), respectively
P for trend <0.001 across all score categories
The healthy lifestyle score ranged from 0 to 7 based on seven lifestyle factors
The study included 306,543 participants aged 38-73 years from the UK Biobank without GERD at baseline
Results
During a mean follow-up of 12.7 years, 27,943 GERD cases were identified, representing 9.1% of the study population.
The sample comprised 306,543 UK Biobank participants free of GERD at baseline
Participants were aged between 38 and 73 years
Mean follow-up duration was 12.7 years
Multivariable Cox regression was used to examine associations
Results
Six of the seven individual healthy lifestyle factors were each independently associated with a lower risk of GERD.
The seven lifestyle items assessed were: never smoking, healthy sleep, moderate BMI, regular physical exercise, moderate alcohol intake, healthy diet, and moderate tea/coffee intake
Moderate alcohol intake was the only factor not significantly associated with GERD risk (HR 1.00; 95% CI: 0.98-1.03)
All other six individual lifestyle factors showed statistically significant inverse associations with GERD risk
Results
The protective association between healthy lifestyle score and GERD risk was more pronounced in younger participants (under 60 years), females, and employed individuals.
Stratified analyses showed stronger associations in participants younger than 60 years
The association was more pronounced among female participants
Employed participants showed stronger associations compared to other employment categories
All interaction P-values were <0.05 for these three subgroups
Background
Lifestyle modifications are recommended by the American Gastroenterological Association for managing GERD, but prior longitudinal evidence for this recommendation was described as scarce.
The study was motivated by a gap between clinical recommendations and available longitudinal evidence
The study design was a prospective population cohort analysis to address this evidence gap
Sensitivity analyses demonstrated results consistent with the main findings
What This Means
This research suggests that adopting multiple healthy lifestyle habits is associated with a substantially lower likelihood of developing gastroesophageal reflux disease (GERD), commonly known as acid reflux. Using data from over 300,000 adults in the UK Biobank followed for nearly 13 years on average, researchers found that the more healthy behaviors a person practiced — including not smoking, getting healthy sleep, maintaining a moderate body weight, exercising regularly, eating a healthy diet, and moderating tea/coffee intake — the lower their risk of developing GERD. People who followed five to seven of these habits had a 37% lower risk compared to those who followed fewer than two.
Almost all individual healthy behaviors were linked to lower GERD risk on their own, with one notable exception: moderate alcohol intake showed no significant protective or harmful association. The benefits of a healthy lifestyle were especially pronounced among younger adults (under 60), women, and employed individuals, suggesting these groups may have the most to gain from lifestyle improvements.
This research matters because GERD affects a large portion of the population and is often managed with medications, but this study provides large-scale prospective evidence supporting lifestyle changes as a meaningful preventive strategy. The findings reinforce existing clinical guidelines recommending lifestyle modification for GERD management and suggest that a combination of healthy habits — rather than any single behavior — offers the greatest protection.
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Peng L, Li X, Qi J, Zhang L, Yang Z, Wu X, et al.. (2026). Healthy lifestyle as a protective factor against the risk of gastroesophageal reflux disease: Prospective population cohort analysis.. PloS one. https://doi.org/10.1371/journal.pone.0360299