Risk Factors For Gallbladder Disease Research Articles

Prevalence of Symptomatic Gallbladder Disease After Bariatric Surgery: A Literature Review.

Introduction Gallbladder disease (GBD) encompasses several medical conditions, including gallbladder stone formation, biliary colic, and cholecystitis. These conditions may arise following bariatric surgery, including bypass or laparoscopic sleeve gastrectomy (LSG). The development of GBD after surgery may be attributed to various factors, including the formation of stones shortly after the procedure, the exacerbation of existing stones due to the surgery, or inflammation of the gallbladder. Rapid weight loss after surgery has also been proposed as a contributing factor. Methodology This observational study consisted of a review of retrospective hospital patient medical records of 350 adult participants who underwent LSG, with 177 participants included in the study after excluding those with cholecystectomy or GBD prior to surgery. The participants were followed for a median of two years, during which we recorded any hospitalizations, emergency department visits, clinic visits, and incidents of cholecystectomy or abdominal pain due to GBD. The participants were grouped into two: those with GBD and those without GBD after bariatric surgery, and quantitative data were summarized using mean and standard deviations. The data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp), with a statistical significance of P<0.05. Results In our retrospective study of 177 patients who underwent LSG, the incidence of GBD after bariatric surgery was 4.5%. Most patients with GBD after bariatric surgery were White, but this difference was not statistically significant. Patients with type 2 diabetes had a higher incidence of GBD after bariatric surgery than those without diabetes (8.3% vs. 3.6%, P=0.355). Patients with HTN had a lower incidence of GBD after bariatric surgery than those without HTN (1.1% vs. 8.2%, P=0.032). Anti-hyperglycemia medication use did not significantly increase the risk of GBD after bariatric surgery (7.5% vs. 3.8%, P=0.389). None of the patients on weight loss medication developed GBD after bariatric surgery, compared to 5% of patients who did not take weight loss medication. Our sub-data analysis showed that patients who developed GBD after bariatric surgery had a high BMI (above 40 kg/m2) before surgery, which decreased to 35 kg/m2 and below 30 kg/m2 at six months and 12 months post-surgery, respectively. Conclusions Our findings demonstrate that the prevalence of GBD after LSG is low and comparable to the general population without LSG. Thus, LSG does not increase the risk of GBD. We found that rapid weight loss after LSG is a significant risk factor for GBD. These findings suggest that patients who undergo LSG should be informed of the risks of GBD and undergo careful screening before surgery to detect any pre-existing gallbladder issues. Overall, our study highlights the importance of continued research into the factors associated with GBD after bariatric surgery and the need for standardized prophylactic measures to prevent this potentially serious complication.

Maternal smoking during pregnancy is risk factor for gallbladder disease in offspring during adulthood: a prospective study from UK Biobank

Gallbladder disease is a common disease with high prevalence. Majority of gallbladder disease is due to gallstone. Though genetics are believed to play a role in its pathogenesis, the contribution of environmental pressures in early life to the development of this disease in adulthood has not been ever investigated. This study aimed to clarify the risk of maternal smoking exposure in association with gallbladder disease in adulthood. The interaction of maternal smoking and own smoking during adulthood on this association was studied as well. A total of 286,731 eligible participants from the UK Biobank population-based cohort were included. Multivariable Cox regression analysis were used to examine the HR and 95% CI with adjustment for covariates. During a median of 8.8 years follow-up, 7110 incident cases of gallbladder disease including 6800 (95.6%) gallstone were identified. Maternal smoking was associated with increased risk of incident total gallbladder disease (HR=1.13; 95%CI: 1.06 - 1.21; P=0.0002) as well as gallstones (HR=1.13; 95%CI: 1.06 -1.21; P=0.0003) in adulthood. Compared with those who were neither exposed to maternal smoking nor own smoking, subjects adherence to no smoking during adulthood but having maternal smoking exposure still had increased risk of total gallbladder disease (HR=1.21; 95%CI: 1.1-1.34, P=0.0001) and gallstones (HR=1.21; 95%CI: 1.1-1.35, P=0.0001). The present study using large prospective cohort data from UK Biobank, for the first time, demonstrated maternal smoking exposure bringing elevated risk of incident total gallbladder disease/gallstone in adulthood.

Epidemiological survey to determine the prevalence of cholecystolithiasis in Uyghur, Kazakh, and Han Ethnic Groups in the Xinjiang Uyghur Autonomous Region of China: cross-sectional studies

BackgroundThis study was performed to understand the prevalence of and possible risk factors for cholecystolithiasis in Uyghur, Kazakh, Han, and other ethnic groups in the Xinjiang Uyghur autonomous region of China.MethodsSubjects were enrolled using typical case sampling and multistage stratified random sampling. We collected epidemiological data regarding cholecystolithiasis using a standard questionnaire of risk factors for gallbladder disease in Xinjiang. The subjects completed the questionnaire and underwent an abdominal ultrasound examination of the liver and gallbladder.ResultsThis study included 5454 Xinjiang residents aged ≥ 18 years. The prevalence of cholecystolithiasis was 15% (11.3% in men and 17.1% in women), and the sex difference was statistically significant (male-to-female odds ratio [OR] 1.867; p < 0.001). The cholecystolithiasis prevalence was also significantly different among the Han, Uyghur, Kazakh, and other ethnic groups (13.1%, 20.8%, 11.5%, and 16.8%, respectively; p < 0.001). The prevalence of cholecystolithiasis in northern Xinjiang was 13.5% and that in southern Xinjiang was 17.5%; this difference was also statistically significant (OR 1.599; p < 0.001). Across all ethnic groups, the cholecystolithiasis prevalence significantly increased with age (all p < 0.01) and body mass index (BMI) (all p < 0.01). A multivariate logistic regression analysis indicated that cholecystolithiasis prevalence was associated with sex, age, BMI, smoking, diabetes, fatty liver disease, and geographical differences between northern and southern Xinjiang.ConclusionsThe prevalence of cholecystolithiasis was significantly higher in the Uyghur ethnic group than in the Han, Kazakh, and other ethnic groups; in women than in men; in southern Xinjiang than in northern Xinjiang; in patients with fatty liver disease; and increased with age and BMI. Our findings could provide a theoretical basis for the formulation of control measures for cholecystolithiasis.

Incidence of and risk factors for late cholecystectomy in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

BackgroundGallbladder disease and need for cholecystectomy are common and significant contributors to patient morbidity and healthcare costs. Childhood cancer survivors are at elevated risk for developing cholelithiasis. However, their incidence of and risk factors for late (>5 years from diagnosis) cholecystectomy have not been studied. MethodsA total of 25,549 survivors (median age at diagnosis 6.9 years, range 0–21.0; current age 30.7 years, range 5.6–65.9) diagnosed between 1970 and 1999 and 5037 siblings were queried for self-reported cholecystectomy occurring five or more years from primary cancer diagnosis. Piecewise exponential models evaluated associations between cancer treatment exposures and late cholecystectomy. ResultsOver a median follow-up period of 21.9 and 26.0 years, respectively, 789 survivors and 168 siblings underwent late cholecystectomy (cumulative incidence 7.2%, 95% confidence interval [CI] = 6.5–7.8% and 6.6%, 95% CI = 5.4–7.6%, respectively; rate ratio [RR] = 1.3, 95% CI = 1.1–1.5). Compared with siblings, survivors of acute lymphoblastic leukaemia (RR = 1.4, 95% CI = 1.2–1.8), soft tissue sarcoma (RR = 1.4, 95% CI = 1.0–1.8) and bone cancer (RR = 1.3, 95% CI = 1.0–1.8) were at the greatest risk. In addition to attained age, female sex and increasing body mass index, exposure to high-dose (≥750 mg/m2) platinum chemotherapy (RR = 2.6, 95% CI = 1.5–4.5), vinca alkaloid chemotherapy (RR = 1.4, 95% CI = 1.1–1.8) or total body irradiation (TBI; RR = 2.2, 95% CI = 1.2–4.2) were each associated with late cholecystectomy. ConclusionsIndependent of traditional risk factors for gallbladder disease, exposure to high-dose platinum chemotherapy, vinca alkaloid chemotherapy or TBI increased risk for late cholecystectomy. These findings should inform current long-term follow-up guidelines and education regarding risk for late cholecystectomy.

Late cholecystectomy in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

e21525 Background: Cholecystectomy (CCY) is among the most common operations performed in the developed world and is offered as a cure for symptomatic gallbladder disease. Whether survivors of childhood cancer undergo CCY at a higher rate than the general population is unknown. Methods: We identified 5-year survivors diagnosed between 1970 and 1999 who self-reported late (&gt; 5 years after cancer diagnosis) CCY. Rates of CCY were determined among the entire cohort and in association with various risk factors and treatment exposures. Adjusted rate ratios (ARR) were estimated with multivariable piecewise exponential models. Results: Among 24,248 survivors (median follow-up 22.3, interquartile range [IQR] 16.2-30.1 years) and 5,038 siblings (median follow-up 26.4, IQR 19.3-33.7 years), the unadjusted cumulative incidence of CCY at age 50 was 7.2% (n = 757) in survivors and 6.5% (n = 168) in siblings. After adjusting for age, sex and race/ethnicity, survivors underwent CCY at higher rates compared to siblings (ARR = 1.3, 95% CI = 1.1-1.5). Relative to siblings, acute lymphoblastic leukemia survivors underwent CCY at a higher rate (ARR = 1.6, 95% CI = 1.3-2.0), all other diagnoses were not independently associated with higher rates of CCY. Among survivors, risk factors for late CCY included female sex, increasing body mass index (BMI) class, exposure to platinum agents and total body irradiation (TBI) (Table). Conclusions: CCY is performed more commonly among childhood cancer survivors relative to siblings. In addition to known risk factors for gallbladder disease, cancer treatment exposures may further enhance risk for CCY. Awareness and education regarding this observation may ensure timely diagnosis and treatment of symptomatic disease. [Table: see text]

Correction: Big data and analysis of risk factors for gallbladder disease in the young generation of Korea

[This corrects the article DOI: 10.1371/journal.pone.0211480.].

Big data and analysis of risk factors for gallbladder disease in the young generation of Korea.

Background/PurposeFew studies have examined the risk factors for gallbladder (GB) disease in young adults. This study aimed to evaluate risk factors for GB disease in young adults based on big data in Korea.MethodsAll participants underwent routine checkup at the Korea Medical Institute from June 2014 to May 2015. After excluding 677 individuals with missing information in records, 724,114 individuals (435,635 men, 288,479 women) were finally included. The definition of abnormal GB finding included stones, sludge, polyps, and adenomyomatosis detected using ultrasonography. All statistical analyses were performed using SAS software version 9.2.ResultsOverall, 27,130 (17.5%) individuals were diagnosed as having abnormal GB finding in the young age group (N = 154,463, aged 20–39 years). In men, significant differences in low-density lipoprotein (LDL) and cholesterol levels were observed between the abnormal GB finding group and normal GB group (p < 0.05). In women, a significant difference in smoking history was noted between the abnormal GB finding group and normal GB group (p < 0.05). The prevalence rate of GB stones was 1.9% (27,979/154,463) in the young age group. High body mass index (BMI), large thigh circumference, and low high-density lipoprotein (HDL) level in women and low HDL level in men were independent risk factors for the presence of GB stones (p < 0.05).ConclusionIn this study, obesity-related factors (BMI, waist size, thigh circumference, and cholesterol, LDL, and HDL levels) correlated with GB disease in the young generation of Korea.

Dietary Intake and Cholelithiasis: A Review.

Gallbladder disease (GBD) is one of the most prevalent gastrointestinal disorders in western societies. Etiology is multifactorial and may follow complex interaction between genetic and environmental factors. Dietary intake has been considered as a potentially modifiable risk factor for GBD, because a number of dietary factors have been involved in cholelithiasis pathogenesis. In our aim to evaluate potential usefulness of diet pattern modification for GBD prevention, we perform a systematic review of related epidemiological studies. We define GBD as a disorder in which a patient bears gallstones and/or undergoes surgery for gallstones. We review English-language studies found in the Med-line database that occurred from 1973 to 2018. We searched for epidemiological evidence of the role of diet as a potential risk factor for gallstone formation. In particular, we thoroughly inspected intake of fatty acid, cholesterol, carbohydrate, protein, fiber, alcohol, nuts, and coffee and vegetarian eating-pattern effects. Our results show that simple sugar (simple carbohydrate) and saturated fat consumption suggests a positive association with the risk for gallstone formation. Protein, fiber, nuts, coffee, and moderate alcohol intake consistently reduces that probability. Different studies found that fat and cholesterol intake are variable risk factors for GBD; therefore, additional analyses are necessary to clarify their relevance in gallstone formation pathogenesis. GBD is a multifactorial disorder that can be affected both positively and negatively by diet. Although no specific dietary recommendations can be addressed to reduce risk for gallstone formation, healthy diet patterns can be expected to improve prospects for healthy gallbladder function.

Sex and ethnic/racial-specific risk factors for gallbladder disease

BackgroundGallbladder disease (GBD) is a highly prevalent condition; however, little is known about potential differences in risk factors by sex and ethnicity/race. Our aim was to evaluate dietary, reproductive and obesity-related factors and GBD in multiethnic populations.MethodsWe performed a prospective analysis from the Multiethnic Cohort study who self-identified as non-Hispanic White (n = 32,103), African American (n = 30,209), Japanese (n = 35,987), Native Hawaiian (n = 6942) and Latino (n = 39,168). GBD cases were identified using Medicare and California hospital discharge files (1993–2012) and self-completed questionnaires. We used exposure information on the baseline questionnaire to identify exposures of interest. Associations were estimated by hazard ratios and 95% confidence intervals using Cox models adjusted for confounders.ResultAfter a median 10.7 years of follow-up, there were 13,437 GBD cases. BMI over 25 kg/m2, diabetes, past and current smoking, red meat consumption, saturated fat and cholesterol were significant risk factors across ethnic/racial populations (p-trends < 0.01). Protective factors included vigorous physical activity, alcohol use, fruits, vegetables and foods rich in dietary fiber (p-trends < 0.01). Carbohydrates were inversely associated with GBD risk only among women and Latinos born in South America/Mexico (p-trend < 0.003). Parity was a significant risk factor among women; post-menopausal hormones use was only associated with an increased risk among White women (estrogen-only: HR = 1.24; 95% CI = 1.07–1.43 and estrogen + progesterone: HR = 1.23; 95% CI = 1.06–1.42).ConclusionOverall, dietary, reproductive and obesity-related factors are strong risk factors for GBD affecting men and women of different ethnicities/races; however some risk factors appear stronger in women and certain ethnic groups.

What Medical Nutrition Therapy Guideline Is Recommended Post-Cholecystectomy?

What Medical Nutrition Therapy Guideline Is Recommended Post-Cholecystectomy?

A study on the Risk factors for Gallbladder diseases in El-khoms Teaching Hospital, Libya

Gallbladder disease (GBD) is one of the most common causes of hospital admission in the developed countries, resulting in a substantial cost to health system. The aim of this study is on demographic, characteristic of GBD patients and the associated risk factors. This case-control study includes 200 patients (cases) with GBD, randomly selected from surgery department at el-khoms teaching hospital, Libya from 1 October 2007 to 30 May 2008. In addition,200 subjects matched with age & sex from other inpatients not suffering from GBD were chosen as controls. Ethical considerations were taken. A detailed history, physical examination, biochemical measurements and abdominal sonography were done. A well formed questionnaire for each subject was filled and full investigations were done. Of all studied subjects (400), males were 240 (60%) and females were 160 (40%) with a mean age of 49.1 years (ranging from 18 to 70 yrs). The rate of GBD among inpatient cases during the study period were 26% with more predominance among females (f/m ratio 5.6:1). Risk factors for GBDs were: positive family history (OR= 1.9, P<0.05), multipara (OR=2.9, P<0.05), use of oral contraceptive pills (OR=2.98, P<0.046), hormone therapy (OR=1.3, P<0.01), high BMI (OR=1.3, P<0.05) and hyperlipidemia (OR=6.3, P<0.01). The rate of GBD was high. This was partly explained by unfavorable body mass index, lipid levels, higher prevalence of diabetes, and a more frequent use of oral contraceptives and hormone therapy in subjects.

Bilirubin, Gallstones, and Mendelian Randomization

Gallstonedisease causes a substantialhealthandeconomicburden in theUnited States andother developed countries.More than 6millionmen and 14millionwomen aged 20 to 74 years in the United States have gallbladder disease.1 Approximately 650 000 to 700 000 cholecystectomies are performed annually in the United States, and the costs associated with the symptoms and complications of gallstones are estimated to be $6.5 billion per year.2 Known risk factors for gallbladder disease includeobesity, recentweight loss, age, hormoneuse, parity, lack of exercise, and alcohol use. We found the article by Stender et al interesting clinically andmethodologically.First, usingobservationaldataandmultivariable analysis to adjust for a variety of known risk factors for gallbladder disease, the authors demonstrate that an elevated plasma bilirubin level is associatedwith a greater likelihood of symptomatic gallbladder disease. Second, using a technique referred to as mendelian randomization, the authors took advantage of the random assortment of genes that occurs during gamete formation. Theydemonstrate that a genetic variant that is associated with increased plasma bilirubin levels is associatedwith an increased likelihood of symptomatic gallstone disease. Because the exposure (the genetic variant) is random, the genetic analysis increases the likelihoodthat the relationshipbetweenplasmabilirubinandsymptomatic gallstone disease is causal. As the human genome is increasingly defined, it is likely that mendelian randomization can become a valuable tool to help confirm or refute whether relationships between other risk factors and diseases are causal.

Gallbladder Disease among Obese Patients in Taiwan

Obesity is a risk factor for gallbladder disease. The authors analyze the prevalence and clinicopathology of gallbladder disease among obese patients in Taiwan. Prevalence and various clinical factors associated with cholelithiasis were studied in 199 patients who were undergoing bariatric surgery for obesity. Clinical data (gender, age, BMI and associated diseases), laboratory evaluation and immunoglobulin G antibodies against Helicobacter pylori were obtained from the patient records. The histopathologic findings of the gallbladder were also examined retrospectively. The degree of acute inflammation, chronic inflammation, cholesterolosis, cholesterol polyp and gastric metaplasia was determined and scored. Of the patients, 91% (n=181) were females and 9% (n=18) were males, age 34.26 +/- 8.41 years, with mean BMI 35.28 +/- 6.11 kg/m2. The prevalence of cholelithiasis was 10.1%. Increased diastolic blood pressure and HBsAg carrier were the only significant factors associated with cholelithiasis. All obese patients in our study presented with variable degrees of chronic mononuclear cell infiltration in the gallbladder mucosa. Cholesterolosis was present in 100 patients (50.3%), followed by gastric metaplasia (27.1%), cholesterol polyp (16.1%) and acute inflammation (9.5%). Multivariate analysis showed an association between cholelithiasis and acute and chronic inflammation. The predictors of cholesterolosis were BMI, waist circumference and high-sensitivity C-reactive protein. The seroprevalence of H. pylori was 42.2%. Older age, abnormal liver function tests, calcium and HBsAg carrier were significantly different between H. pylori-seropositive and H. pylori-seronegative obese patients. However, we could rarely find H. pylori within the gallbladder mucosa. Cholelithiasis in Asian obese patients is significantly associated with increased diastolic blood pressure and hepatitis B surface antigen carriers. Because chronic liver disease seems to be a risk factor for cholelithiasis in both non-obese and obese populations, prophylactic cholecystectomy can be considered in obese patients with HBsAg positivity. We did not find evidence that H. pylori has a role in the pathogenesis of gallbladder disease and gallstone by histologic and serologic examinations. Furthermore, mucosal abnormalities of acute and chronic inflammatory cell infiltration are common in obese patients, which related to cholelithiasis.

Comparison of artificial neural networks with logistic regression in prediction of gallbladder disease among obese patients

Background Obesity is a risk factor for gallbladder disease. The authors retrospectively analyse the prevalence and risk factors of gallbladder disease using logistic regression and artificial neural networks among obese patients in Taiwan. Methods Artificial neural networks is a popular technique, which can detect complex patterns within data. They have not been applied to risk of gallbladder disease in obese population. We studied the risk factors associated with gallstones in 117 obese patients who were undergoing bariatric surgery between February 1999 and October 2005. Artificial neural networks, constructed with three-layered back-propagation algorithm, were trained to predict the risk of gallbladder disease. Thirty input variables including clinical data (gender, age, body mass index and associated diseases), laboratory evaluation and histopathologic findings of gallbladder were obtained from the patient records. The result was compared with a logistic regression model developed from the same database. Results Artificial neural networks demonstrated better average classification rate and lower Type II errors than those of logistic regression. The risk factors from both data mining techniques were diastolic blood pressure, inflammatory condition, abnormal glucose metabolism and cholesterolosis. The biological significance of inflammatory condition in obese population requires further investigation. Conclusion Artificial neural networks might be a useful tool to predict the risk factors and prevalence of gallbladder disease and gallstone development in obese patients on the basis of multiple variables related to laboratory and pathological features. The performance of artificial neural networks was better than traditional modeling techniques.

43: Routine cholecystectomy is not mandatory during surgery for the morbidly obese

Rapid weight loss is a risk factor for gallbladder disease. Despite this many bariatric patients do not develop gallbladder pathology. We report our single institution experience of 621 bariatric operations without the routine use of cholecystectomy.

Alternative treatment of gallbladder disease

Major risk factors for gallbladder disease include a sedentary lifestyle and a diet rich in refined sugars. In genetically prone individuals, these two factors lead to an abnormal bile composition, altered gut microflora, and hyperinsulinemia, with resulting gallstone formation. As a large percentage of gallbladder patients have continued digestive complaints following cholecystectomy, the author examines complementary and alternative medicine (CAM) treatments to counteract gallstone formation. Herbal medicine such as turmeric, oregon grape, bupleurum, and coin grass may reduce gallbladder inflammation and relieve liver congestion. Elimination of offending foods, not necessarily ‘fatty’ foods, is often successful and recommended by many holistic physicians. Regular aerobic exercise has a beneficial effect on hyperinsulinemia, which is often associated with gallbladder disease. Dietary changes that lower plasma insulin levels, such as a change in dietary fats and substitution of unrefined carbohydrates for refined carbohydrates, may also be helpful.

Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease.

Morbid obesity is one of the major risk factors for gallbladder disease, and this risk is even greater following rapid weight loss. Because of this, prophylactic cholecystectomy has been offered to our patients undergoing the transected silastic ring vertical Roux-en-Y gastric bypass (TSRVRYGBP). A study was undertaken to determine the incidence of pathologic gallbladders in patients undergoing this prophylactic cholecystectomy. The records of all patients who underwent TSRVRYGBP from June 1999 through December 2000 were reviewed. Pathologic findings of the gallbladder were documented as cholelithiasis, cholecystitis, cholesterolosis, polyps or normal. 761 patients underwent the operation. 178 patients (23%) had cholecystectomy before the surgery. 154 (20%) had gallstones documented by ultrasound and had cholecystectomy at the time of the surgery. 324 of the 429 patients with negative preoperative findings by ultrasound had pathologic evidence of gallbladder disease. Because of the high incidence of gallbladder disease even with negative preoperative findings in morbidly obese patients and the lack of significant morbidity with cholecystectomy in experienced hands, routine cholecystectomy at the time of the weight loss operation is justified.

Relationship of serum leptin concentration and other measures of adiposity with gallbladder disease

Obesity increases the risk of gallstones, especially in women. Most gallbladder disease studies have used body mass index (BMI) as a measure of overall adiposity, although BMI does not distinguish between fat and lean body mass. Central adiposity may also increase gallstone risk, although this is less well studied. Leptin is a peptide whose serum concentration is highly correlated with total body fat mass. We examined the relationship of gallbladder disease with anthropometric measures and serum leptin concentration in a large, national, population-based study. A total of 13,962 adult participants in the Third National Health and Nutrition Examination Survey underwent gallbladder ultrasonography and anthropometric measurements of BMI, body circumferences, and skinfold thicknesses, and a random subgroup of 5,568 had measures of fasting serum leptin concentrations. Gallstone-associated gallbladder disease was defined as ultrasound-documented gallstones or evidence of cholecystectomy. When controlling for BMI and other gallbladder disease risk factors in multivariate analysis, a test for trend for increasing waist-to-hip circumference ratio and risk of gallbladder disease was statistically significant among women (P = .043) and men (P = .007). BMI remained strongly associated with gallbladder disease among women (P < .001), but was unrelated among men (P = .46). Leptin concentration was associated with gallbladder disease in both sexes (P < .001), but not after controlling for BMI and waist-to-hip circumference in either women (P = .29) or men (P = .65). In conclusion, waist-to-hip circumference ratio was related to gallbladder disease among women and men. Serum leptin concentration was not a better predictor of gallbladder disease than anthropometry. (HEPATOLOGY 2001;34:877-883.)

Dietary intake and gallbladder disease: a review.

Dietary intake has long been looked upon as a potentially modifiable risk factor for gallbladder disease (GBD), here defined as either having gallstones or having had surgery for gallstones. This paper reviews the epidemiological evidence for an association between dietary intake and GBD, focusing on six dietary factors that have received the most attention in studies in this area: energy intake, fatty acids, cholesterol, carbohydrates and fibre, calcium and alcohol. The objectives of this review are to evaluate the potential usefulness of altering the diet to prevent GBD and to consider future research in this area. We reviewed all English-language epidemiological studies on diet and cholelithiasis that were cross-sectional, cohort or case-control in design and that were indexed in the Medline database from 1966 to October 1997. A positive association was suggested with simple sugars and inverse associations with dietary fibre and alcohol. No convincing evidence was found for a role for energy intake or intake of fat or cholesterol. Variable means of ascertaining cases and inaccurate measurement of dietary intake may contribute to variation in results across studies. Some specific components of the diet that may affect GBD include simple sugars, fibre and alcohol, but whether risk for GBD can be reduced by altering intake of a specific dietary factor has not been established. Although no specific dietary recommendations can be made to reduce risk of GBD per se, a 'healthy' diet aimed at reducing risk of other diseases might be expected to reduce risk for GBD as well.

Genetic determinants of variation in gallbladder disease in the Mexican-American population.

Since there have not been any studies that quantify the influence of genetic factors on gallbladder disease (GBD) in humans using information from families, we utilized pedigree data to explore the genetic control of variation in liability to GBD. Using an extension of a variance components approach, we performed genetic analyses of GBD using information from 32 low-income Mexican-American families with two slightly different general models incorporating several sex-specific GBD risk factors. After evaluating the relative magnitudes of the covariate effects from these two models, we identified a parsimonious model including only significant predictors of GBD. According to this model, heritability for GBD was high (h2 = 0.44+/-0.18), after accounting for the significant effects of age, leptin in both sexes, total cholesterol, and HDL cholesterol in males only. We have shown quantitatively that variation in GBD is under strong genetic control. However, there are two major limitations to our findings: (1) since GBD was defined by a self-reported clinical history rather than an ultrasound examination, the prevalence of GBD could have been underestimated; and (2) since our design did not allow for shared environmental effects, our estimate of heritability may have been inflated.