Abstract
Vegetarian diets may lower symptomatic gallstone disease via cholesterol lowering. This study aimed to examine the risk of symptomatic gallstone disease (GSD) in Taiwanese vegetarians vs. nonvegetarians in a prospective cohort and to explore if this association is related to cholesterol concentration. We prospectively followed 4839 participants, and in the 29,295 person-years of follow-up, 104 new incident GSD cases were confirmed. Diet was assessed through a validated food frequency questionnaire. Symptomatic GSD was ascertained through linkage to the Taiwan National Health Insurance Research Database. Blood cholesterol profiles were measured at recruitment. Cox regression was applied to assess the effect of diet on symptomatic GSD, adjusting for age, education, smoking, alcohol, physical activities, diabetes, kidney diseases, body mass index, lipid-lowering medication, and hypercholesterolemia. Vegetarian diet was associated with a decreased risk of symptomatic GSD compared with nonvegetarian diet in women (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28–0.96) but not in men. In women, nonvegetarians with hypercholesterolemia had 3.8 times the risk of GSD compared with vegetarians with normal cholesterol (HR, 3.81, 95% CI, 1.61–9.01). A vegetarian diet may therefore protect against GSD independent of baseline hypercholesterolemia. A nonvegetarian diet and hypercholesterolemia may have an additive effect in increasing GSD risk in women.
Highlights
Gallstone disease (GSD) is a worldwide disease
Some studies have suggested that fruit and vegetable consumption decreases the risk of cholecystectomy in women [5,6,7,8], but the European EPIC-Oxford study showed that a vegetarian diet is a risk factor for symptomatic GSD [9]
In our subgroup analysis by cholesterol concentration (Table 4), we found vegetarian women had a 66% decrease in symptomatic GSD risk compared with nonvegetarian women (HR, 0.34; 95% confidence interval (CI), 0.14–0.82) among those with normal total cholesterol (TCH) but only a nonsignificant 23% (HR, 0.77; 95% CI, 0.33–1.79)
Summary
Some studies have suggested that fruit and vegetable consumption decreases the risk of cholecystectomy in women [5,6,7,8], but the European EPIC-Oxford study showed that a vegetarian diet is a risk factor for symptomatic GSD [9]. Most of these studies are from the Western population, so the effect of vegetarian dietary patterns on the development of symptomatic GSD in the Asian population is unknown
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