The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn

Young Kwan Kim; Jeong Seop Moon; Soo Hyung Ryu; Jung Hwan Lee; You Sun Kim

doi:10.4166/kjg.2010.55.2.109

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Kim, Moon, Ryu, Lee, and Kim: The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn

Original Article

Korean J Gastroenterol 2010;55(2):109-118.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.2.109

The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn

Young Kwan Kim, M.D., Jeong Seop Moon, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D., You Sun Kim, M.D.

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to: Jeong Seop Moon, M.D. Department of Internal Medicine, Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 100-032, Korea Tel: +82-2-2270-0012, Fax: +82-2-2279-4021 E-mail: moonjs2@unitel.co.kr

Received 16 June 2009 Accepted 28 July 2009

Abstract

Background/Aims

The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn.

Methods

We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005.

Results

Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=−0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=−0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p＜0.001). Regular milk caused more heartburn than low-fat milk (p=0.008).

Conclusions

Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn.

Keywords: Heartburn, Beverage, pH, Osmolality, Titratable acidity

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Fig. 1.

Relationship between titratable acidity of citrus juices and heartburn scores (r=0.78; p=0.023).

Fig. 2.

Relationship between pH of alcoholic beverages and heartburn scores (r=0.84; p=0.037).

Fig. 3.

Relationship between osmolality of alcoholic beverages and heartburn scores (r=−0.86; p=0.028).

Fig. 4.

Relationship between ethanol concentration of alcoholic beverages and heartburn scores (p＞0.05).

Table 1.

Osmolality, pH, Titratable Acidity, and Heartburn Scores of Beverages Studied

Beverage (no. of respondents)	pH	Osmolality (mOsm/kg)	Titratable acidity (mEq/L)	Heartburn score (%)^∗
Water (108)	7.19	64	0	0.27 (19.4)
Citrus juices
Orange juice (Del Monte) (127)	3.79	605	114.2	0.83^† (66.9)
Grape juice (Lotte chilsung Co.) (106)	3.03	879	67.8	0.38^‡ (29.2)
Tomato juice (Del Monte) (98)	3.89	494	61.2	0.34^‡ (24.5)
Apple juice (Ildong foodis Co.) (101)	3.71	681	47.9	0.48^† (38.6)
Carrot juice (Lotte chilsung Co.) (89)	4.16	528	64.2	0.18 (13.5)
Japanese apricot juice (Lotte chilsung Co.) (90)	2.79	856	56.5	0.39^‡ (31.1)
Pineapple juice (Del Monte) (98)	3.65	698	90.7	0.48^† (39.8)
Aloe juice (Lotte chilsung Co.) (83)	3.34	597	21.9	0.22 (18.1)
Soft drinks
Pepsi-cola (Pepsico Inc.) (124)	2.54	616	40.9	0.85^† (68.5)
Diet coke (Coca-Cola Co.) (84)	2.87	71	35.6	0.73^† (53.6)
Chilsung cider (Lotte chilsung Co.) (103)	2.95	572	44.3	0.67^† (53.4)
Fanta orange (Coca-Cola Co.) (94)	2.72	810	40.1	0.60^† (45.7)
Sports drinks
Pocarisweat (Donga-Otsuka Co.) (91)	3.41	305	30.4	0.24 (17.6)
Gatorade (Pepsico Inc.) (85)	2.96	331	41.1	0.25^† (20.0)
Coffee, tea and Korean drinks
Lets be coffee (Lotte chilsung Co.) (134)	6.90	335	0.2	1.15^† (86.6)
Decaffeinated coffee (Dongsuh food Co.) (90)	6.05	265	5.7	0.87^† (62.2)
Ceylon tea (Lotte chilsung Co.) (87)	3.08	398	14.2	0.45^‡ (33.3)
Green tea (Lotte chilsung Co.) (99)	6.39	69	0.5	0.44^‡ (35.3)
Chocolate drink (Hershey foods Co.) (84)	6.51	481	4.2	0.39^‡ (28.6)
Fermented rice punch (Lotte chilsung Co.) (102)	5.79	385	1.1	0.22 (15.7)
Sweet cinnamon punch (Korea yakult Co.) (94)	6.57	418	0.3	0.26 (21.3)
Honeyed water (Hoyeondang) (95)	4.18	968	2.0	0.32^‡ (24.2)
Oolong tea (Dongsuh food Co.) (78)	5.61	68	1.0	0.17 (12.8)
Bacchus (Dong-a pharm Co.) (92)	2.71	774	80.8	0.60^† (47.8)
Alcoholic beverages
Beer (Hite Co.) (92)	4.04	118	39.1	0.79^† (60.9)
Chamisul soju (Jinro Co.) (117)	7.62	72	0	1.12^† (84.6)
Chivas regal (83)	4.01	66	2.9	0.96^† (73.5)
Makgeolli, raw rice wine (Sorak yangjo) (85)	3.66	153	63.2	0.76^† (57.6)
Refined rice wine (Doosan Co.) (71)	3.53	307	30.2	0.63^† (46.5)
Red wine (Jinro Co.) (68)	3.12	541	38.6	0.53^† (42.6)
Milks
Regular milk (Seoul milk Co.) (107)	6.58	273	4.8	0.63^† (45.8)
Low-fat milk (Seoul milk Co.) (92)	6.63	268	4.4	0.40^‡ (29.3)
Soybean milk (Samyuk Co.) (93)	6.29	291	7.4	0.28^‡ (23.7)
Yogurt (Namyang Co.) (99)	3.58	948	66.3	0.33^‡ (27.3)

^∗ Sum of individual scores (0, none; 1, occasional; 2, frequent) divided by the number of respondents. Number in parentheses is the percent of respondents who reported heartburn (either occasional or frequent).

^† p＜0.001 vs. water.

^‡ p＜0.05 vs. water.

Table 2.

Prevalence of Frequent Heartburn Reported with Beverages Studied

Beverage (no. of respondents)	No. with frequent heartburn^∗ (%)^†
Water (108)	8 (7.4)
Citrus juices
Orange juice (127)	20 (15.7)
Grape juice (106)	9 (8.5)
Tomato juice (98)	9 (9.2)
Apple juice (101)	9 (8.9)
Carrot juice (89)	4 (4.5)
Japanese apricot juice (90)	7 (7.8)
Pineapple juice (98)	8 (8.2)
Aloe juice (83)	3 (3.6)
Soft drinks
Pepsi-cola (124)	20 (16.1)
Diet coke (84)	16 (19.0)
Chilsung cider (103)	14 (13.6)
Fanta orange (94)	13 (13.8)
Sports drinks
Pocarisweat (91)	6 (6.6)
Gatorade (85)	4 (4.7)
Coffe, tea and Korean drinks
Regular coffee (134)	38 (28.4)
Decaffeinated coffee (90)	22 (24.4)
Ceylon tea (87)	10 (11.5)
Green tea (99)	9 (9.1)
Chocolate drink (84)	9 (10.7)
Fermented rice punch (102)	6 (5.9)
Sweet cinnamon punch (94)	4 (4.3)
Honeyed water (95)	7 (7.4)
Oolong tea (78)	3 (3.8)
Bacchus (92)	11 (12.0)
Alcoholic beverages
Beer (92)	17 (18.5)
Chamisul soju (117)	32 (27.4)
Chivas regal (83)	19 (22.9)
Makgeolli, raw rice wine (85)	16 (18.8)
Refined rice wine (71)	12 (16.9)
Red wine (68)	7 (10.3)
Milks
Regular milk (107)	18 (16.8)
Low-fat milk (92)	10 (10.9)
Soybean milk (93)	4 (4.3)
Yogurt (99)	6 (6.1)

^∗ Values are number of respondents with frequent heartburn to each beverage.

^† Values in parentheses are the percent of respondents who reported frequent heartburn among those answered (either frequent or occasional or no heartburn) to each beverage.

Table 3.

Correlation between Ethanol Concentration of Alcoholic Beverages and Heartburn Scores

	Ethanol concentration (%)	Heartburn scores	p-value
Beer	4.5	0.79
Chamisul soju	21	1.12
Chivas regal	40	0.96
Makgeolli, raw rice wine	6	0.76	p=0.241
Refined rice wine	13	0.63
Red wine	10	0.53

Table 4.

Correlation between Body Mass Index and Heartburn

	With heartburn	Without heartburn	p-value
No. of respondents	190	137
BMI^∗, mean (kg/m²)	22.75	26.10	0.253

^∗ BMI, body mass index, was calculated as the weight in kilograms divided the height in meters squared.

Table 5.

Correlation between Smoking and Heartburn^∗

	No. with heartburn (%)	No. without heartburn (%)	Total (%)	p-value^†
Smoker	37 (66.1)	19 (33.9)	56 (100)	p=0.191
Non-smoker	106 (59.2)	73 (40.8)	179 (100)
Ex-smoker	45 (51.1)	43 (48.9)	88 (100)
Total	188 (58.2)	135 (41.8)	323 (100)

^∗ Values are given as number (percentage) of respondents.

^† Correlation between smoking and heartburn was obtained by Pearson chi-square test after comparing the ratio of respondents with heartburn among each smoking state (smoker, non-smoker, ex-smoker).

Table 6.

Difference in Lifestyle of Subjects with or without Heartburn

Questions	With heartburn∗ (n=224)	Without heartburn^∗ (n=150)	p-value
How often do you			＜0.0001
experience heartburn?
Daily	19	4
2-5 times a week	39	7
Once a week	32	4
1-2 times a month	39	13
Less than once a month	34	35
Do you experience			0.0053
heartburn after overeating?
Always	18	2
Sometimes	105	33
Never	59	37
Do not overeat	8	8
Do you have a			0.0054
midnight snack?
Daily	15	11
2-5 times a week	42	26
Once a week	54	11
1-2 times a month	23	8
Less than once a month	12	15
Never	48	22
When do you go to bed			0.8533
after midnight snack?
Immediately after	10	5
30 minutes later	34	12
1 hour later	72	32
2 hours later	32	18
Over 3 hours later	9	3

^∗ Values are given as number of respondents.

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