The effect of dietary intake, physical activity and posture on pepsin concentrations detected in the saliva of free-living, healthy individuals

Introduction: Diet and lifestyle are believed to be major causes of gastric reflux. The occurrence of reflux is associated with a number of respiratory, oesophageal and airways conditions. Previous studies have used oesophageal monitoring to assess the occurrence of reflux events. Such measurements may only measure "bulk" rather than "microreflux" events. Such technology is also likely to impact on both habitual dietary intake and physical activity due to the nature of the assessment. Aim: To assess the impact of meal intake and physical activity on pepsin concentrations in saliva collected from free-living individuals throughout the day. Methods: Fifty-one participants (aged 18+, non-smokers with no current chronic or acute respiratory conditions, bloodborne diseases, or diagnosis of reflux disease) provided saliva samples before (< 30 min) and after (< 1 h) meals and physical activity bouts or before and after sleep. Dietary intake and physical activity were monitored by diary over this time. Dietary intake was analyzed using Windiets® software, while physical activity output was calculated from pre-existing tables of energy expenditure. Saliva samples were analyzed for pepsin content using a previously described ELISA methodology. Wilcoxon matched pairs rank sign tests were performed on before- and after-meal/physical activity/sleep samples. Results: Fifty-seven paired pre-and post-meal,48 paired pre- and post-physical activity samples and 168 pre- and post-sleep samples were analyzed. Mean(standard deviation) pepsin concentrations in saliva were significantly higher (P=0.037) in the pre-meal samples (44.2(42.2)) than the post-meal samples (32.8(29.6)). Post-sleep pepsin concentrations (196.4(323.4)) were significantly higher (P< 0.001) than pre-sleep (102.3(152.8)). There was no significant difference (P=0.491) between pre-(45.2(56.8)) and post-(40.8(38.6)) physical activity saliva samples. Conclusions: Analysis of pepsin in saliva is a useful method to assess the impact of lifestyle on reflux event occurrence. Increased preprandial salivary pepsin concentrations may be due to microreflux events driven by the cephalic phase of digestion.