High dietary carbohydrates decrease gallbladder volume and enhance cholesterol crystal formation

The association between life's essential 8 and gallstones: A cross-sectional study

This study investigates the relationship between Life's Essential 8 (LE8), a measure of cardiovascular health (CVH), and the risk of gallstones in adult Americans. We analyzed data from 5,024 participants aged 20 and older, using information from the 2017-2020 National Health and Nutrition Examination Survey. Gallstone presence was determined via a standard questionnaire. LE8 scores, representing four health behaviors (sleep, tobacco/nicotine exposure, physical activity, and diet) and four health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure), were categorized into low, moderate, and high CVH groups. Weighted logistic regression, restricted cubic splines (RCS), and stratified analyses were used to assess the association between LE8 and gallstones. Of the 5,024 participants, 543 (11.22%) had gallstones. In fully adjusted models, participants with high CVH (LE8 ≥ 80) had a 59% lower risk of gallstones compared to those with low CVH (LE8 < 50) (OR: 0.41, 95% CI: 0.23-0.72, P = 0.010). RCS analyses suggested a nonlinear relationship between LE8 and gallstones. Stratified analysis showed a stronger association in participants under 65 (OR: 0.26, 95% CI: 0.15-0.44), females (OR: 0.44, 95% CI: 0.24-0.81), those with higher education (OR: 0.39, 95% CI: 0.19-0.78), non-white individuals (OR: 0.28, 95% CI: 0.13-0.60), and married participants (OR: 0.40, 95% CI: 0.20-0.80).Higher CVH, as measured by LE8, is associated with a lower risk of gallstones among adult Americans.

Association between weight-adjusted-waist index and the prevalence of gallstone disease in Minhang District, Shanghai: a cross-sectional study

BACKGROUND

Gallstone disease (GSD) is a common and costly health issue with a multifactorial etiology linked to obesity. The Weight-Adjusted-Waist Index (WWI) is a novel anthropometric measure that incorporates both weight and waist circumference, potentially offering a better assessment of GSD risk associated with adiposity. This study aims to evaluate the association between WWI and the prevalence of GSD.

METHODS

We conducted a cross-sectional study involving 19,426 participants divided into stone (n = 4,398) and non-stone (n = 15,028) groups based on ultrasound-confirmed GSD. WWI was calculated, and its association with GSD was analyzed using logistic regression models, adjusting for confounders such as age, gender, and comorbid conditions.

RESULTS

The prevalence of GSD was 22.6%. Participants with GSD had a higher mean age, a greater proportion of females, and higher Body Mass Index (BMI) compared to those without GSD. WWI was significantly higher in the stone group (p < 0.001). The prevalence of fatty liver was also higher in the stone group (p < 0.001). Laboratory findings indicated a subclinical inflammatory state in participants with GSD. The highest tertile of WWI was associated with an increased odds ratio for GSD (OR = 1.23, 95% CI: 1.13-1.35 in the fully adjusted model). WWI demonstrates superior predictive ability for gallstones compared to other obesity markers in obese populations.

CONCLUSIONS

WWI is positively associated with the prevalence of GSD, independent of traditional risk factors. These findings suggest that WWI could serve as a practical screening tool to identify individuals at higher risk for GSD, emphasizing the need for targeted interventions to address central obesity.

Associations between temporal eating patterns and energy distribution patterns with gallstones: a cross-sectional study based on NHANES 2017-2018

BACKGROUND

Gallstones are strongly associated with eating occasion (EO) and energy distribution, but few studies have addressed this aspect. Therefore, we utilize the data from 2017 to 2018 National Health and Nutrition Examination Survey (NHANES) to explore the association between temporal eating patterns and energy distribution patterns with the incidence of gallstones.

METHODS

Our study comprised participants who completed the NHANES dietary intake interview and self-reported health questionnaire at age 20 or older. The self-report method for gallstones (have you ever been told by a doctor) was used. We use the latent class analysis (LCA) identified temporal eating patterns, and identified energy distribution patterns through latent profile analysis (LPA). The association between temporal eating patterns, energy distribution patterns, and gallstones was examined using logistic regression modeling.

RESULTS

The study included a total of 4,692 participants. LCA identified four temporal eating patterns labeled as "Conventional," "Early breakfast," "Later breakfast," and "Grazing." Compared to the "Conventional" pattern, the "Early breakfast" pattern (OR 0.809, 95%CI 0.808-0.811) was associated with a reduced risk of gallstones, while the "Later breakfast" (OR 1.435, 95%CI 1.432-1.438) and "Grazing" (OR 1.147, 95%CI 1.145-1.148) patterns were associated with an increased risk of gallstones. LPA identified four energy distribution patterns labeled as "Guideline," "High carbohydrates," "Carbs-fat balance," and "High fat." The "High carbohydrates" pattern (OR 1.329, 95%CI 1.326-1.331) was associated with an increased risk of gallstones compared to the "Guideline" pattern. The "Carbs-fat balance" pattern (OR 0.877, 95%CI 0.876-0.879) and the "High fat" pattern (OR 0.848, 95%CI 0.846-0.850) were significantly and negatively associated with the risk of gallstones.

CONCLUSIONS

To summarize, inappropriate timing of eating and energy sources are associated with gallstones. As a dietary prevention measure for gallstones, we suggest adhering to a regular eating routine and avoiding overly casual and frequent food consumption. If the main EO routine occurs in the morning, this time should not exceed 9:00 a.m. Additionally, reducing carbohydrate intake and maintaining a moderate level of fat intake is believed to contribute to a lower risk of gallstones.

Mendelian randomization study on the causal relationship between food and cholelithiasis

BACKGROUND

Cholelithiasis, commonly referred to as gallstones, is a prevalent medical condition influenced by a combination of genetic factors, lifestyle choices, and dietary habits. Specific food items have been associated with an increased susceptibility to cholelithiasis, whereas others seem to offer a protective effect against its development.

METHODS

In this study, we conducted a Mendelian randomization (MR) analysis using a large-scale genetic dataset comprising individuals with European ancestry to explore the potential causal relationship between diet and cholelithiasis. The analysis incorporated 17 food-related variables, which were considered as potential factors influencing the occurrence of this condition.

RESULTS

Our findings indicate that a higher consumption of cooked vegetables, dried fruit, and oily fish is associated with a reduced risk of cholelithiasis. Conversely, a higher consumption of lamb is associated with an increased risk of developing the condition. Importantly, these associations proved robust to sensitivity and heterogeneity tests, and the pleiotropic test results further supported the hypothesis of a causal relationship between diet and cholelithiasis.

CONCLUSION

Through our study, we provide compelling evidence for the existence of a causal relationship between diet and cholelithiasis. Adopting a dietary pattern enriched with cooked vegetables, dried fruit, and oily fish, while minimizing lamb intake, may contribute to the prevention of cholelithiasis. Recognizing diet as a modifiable risk factor in the prevention and management of this condition is of paramount importance, and our study offers valuable insights in this regard.

Dietary Patterns and Gallstone Risks in Chinese Adults: A Cross-sectional Analysis of the China Multi-Ethnic Cohort Study

BACKGROUND

Little is known about the association between a plant-based diet and the risk of gallstone disease (GD), especially in developing counties. We tested the hypothesis that shifting dietary patterns would be related to the risk of GD, and that the Mediterranean diet (MED) adjusted for China would be beneficial for lowering risk of GD.

METHODS

Data were extracted from the baseline survey of the China Multi-Ethnic Cohort study. An alternative Mediterranean diet (aMED) score was assessed based on a food frequency questionnaire, and three posteriori dietary patterns (the modern dietary pattern, the coarse grain dietary pattern, and the rice dietary pattern) were identified using factor analysis. Multivariable logistic regression models were developed to evaluate the association between dietary patterns and GD risks.

RESULTS

A total of 89,544 participants were included. The prevalence of GD was 7.5%. Comparing the highest with lowest quintiles, aMED was associated with an increased risk of GD (OR 1.13; 95% CI, 1.04-1.24; Ptrend = 0.003), whereas the rice dietary pattern was inversely related to GD risk (OR 0.79; 95% CI, 0.71-0.87; Ptrend < 0.001). In stratified analysis, the rice dietary pattern had a stronger inverse association in the subgroups of females, older, urban, and overweight participants, and those with diabetes-factors associated with higher rates of GD in previous studies.

CONCLUSION

Higher adherence to the rice dietary pattern was associated with a lower risk of GD. For high-risk populations, making some shift to a traditional agricultural diet might help with primary prevention of GD.

Cholesterol cholelithiasis: part of a systemic metabolic disease, prone to primary prevention

Cholesterol gallstone disease have relationships with various conditions linked with insulin resistance, but also with heart disease, atherosclerosis, and cancer. These associations derive from mechanisms active at a local (i.e. gallbladder, bile) and a systemic level and are involved in inflammation, hormones, nuclear receptors, signaling molecules, epigenetic modulation of gene expression, and gut microbiota. Despite advanced knowledge of these pathways, the available therapeutic options for symptomatic gallstone patients remain limited. Therapy includes oral litholysis by the bile acid ursodeoxycholic acid (UDCA) in a small subgroup of patients at high risk of postdissolution recurrence, or laparoscopic cholecystectomy, which is the therapeutic radical gold standard treatment. Cholecystectomy, however, may not be a neutral event, and potentially generates health problems, including the metabolic syndrome. Areas covered: Several studies on risk factors and pathogenesis of cholesterol gallstone disease, acting at a systemic level have been reviewed through a PubMed search. Authors have focused on primary prevention and novel potential therapeutic strategies. Expert commentary: The ultimate goal appears to target the manageable systemic mechanisms responsible for gallstone occurrence, pointing to primary prevention measures. Changes must target lifestyles, as well as experimenting innovative pharmacological tools in subgroups of patients at high risk of developing gallstones.

The Role of Diet in the Pathogenesis of Cholesterol Gallstones

Cholesterol gallstone disease is a major health problem in Westernized countries and depends on a complex interplay between genetic factors, lifestyle and diet, acting on specific pathogenic mechanisms. Overweigh, obesity, dyslipidemia, insulin resistance and altered cholesterol homeostasis have been linked to increased gallstone occurrence, and several studies point to a number of specific nutrients as risk- or protective factors with respect to gallstone formation in humans. There is a rising interest in the identification of common and modifiable dietetic factors that put the patients at risk of gallstones or that are able to prevent gallstone formation and growth. In particular, dietary models characterized by increased energy intake with highly refined sugars and sweet foods, high fructose intake, low fiber contents, high fat, consumption of fast food and low vitamin C intake increase the risk of gallstone formation. On the other hand, high intake of monounsaturated fats and fiber, olive oil and fish (ω-3 fatty acids) consumption, vegetable protein intake, fruit, coffee, moderate alcohol consumption and vitamin C supplementation exert a protective role. The effect of some confounding factors (e.g., physical activity) cannot be ruled out, but general recommendations about the multiple beneficial effects of diet on cholesterol gallstones must be kept in mind, in particular in groups at high risk of gallstone formation.

The Prevalence of Gallstone Disease Is Significantly Lower in Natives than in Migrants of Jeju Island

BACKGROUND

The eating habits of Jeju Island natives are quite different from those of the mainland people because of geographic isolation. Diet is a main factor affecting gallstone disease. We investigated the prevalence of gallstone disease in both Jeju Island natives and migrants and studied the risk factors affecting gallstone disease in the Jeju Island people.

METHODS

A total of 20,763 subjects who underwent medical checkups at the Health Promotion Center of Jeju National University Hospital in Korea from January 2003 to December 2015 were enrolled in the study. Ultrasonography was used to determine the presence of gallbladder stones. Body mass index and biochemical parameters, including liver function test results, lipid profiles, and fasting blood glucose levels, were verified, and data on age, birthplace, and sex were collected from medical records. Univariate and multivariate analyses were performed to identify risk factors affecting gallstone disease.

RESULTS

The prevalence of gallstone disease in the Jeju Island people was 4.0%: Jeju Island natives, 3.8% and migrants, 4.4% (P=0.047). After multivariate logistic regression analysis, the independent risk factors were older age, Jeju migrants, higher fasting blood glucose and alanine aminotransferase levels, and lower high-density lipoprotein cholesterol levels.

CONCLUSION

The prevalence of gallstone disease was significantly lower in natives than in migrants from Jeju Island. Older age, Jeju migrants, higher fasting blood glucose and alanine aminotransferase levels, and lower highdensity lipoprotein cholesterol levels contributed to gallstone disease prevalence in the Jeju Island people.

Does gallbladder angle affect gallstone formation?

INTRODUCTION

Morphology of gallbladder varies considerably from person to person. We believe that one of the morphological variations of gallbladder is the "gallbladder angle". Gallbladder varies also in "angle", which, to the best of our knowledge, has never been investigated before. The purpose of this study was to investigate the impact of gallbladder angle on gallstone formation.

METHODS

in this study, 1075 abdominal computed tomography (CT) images were retrospectively examined. Patients with completely normal gallbladders were selected. Among these patients, those with both abdominal ultrasound and blood tests were identified in the hospital records and included in the study. Based on the findings of the ultrasound scans, patients were divided into two groups as patients with gallstones and patients without gallstones. Following the measurement of gallbladder angles on the CT images, the groups were statistically evaluated.

RESULTS

The gallbladder angle was smaller in patients with gallstones (49 ± 21 degrees and 53 ± 19 degrees) and the gallbladder with larger angle was 1.015 (1/0.985) times lower the risk of gallstone formation. However, these were not statistically significant (p>0,05).

CONCLUSION

A more vertically positioned gallbladder does not affect gallstone formation. However, a smaller gallbladder angle may facilitate gallstone formation in patients with the risk factors. Gallstones perhaps more easily and earlier develop in gallbladders with a smaller angle.

Steatocholecystitis: the influence of obesity and dietary carbohydrates

INTRODUCTION

We have recently demonstrated that obese and lean mice fed a high fat diet have increased gallbladder wall fat and decreased gallbladder contractility, cholecystosteatosis. Animal and human data also suggest that diets high in refined carbohydrates lead to gallstone formation. However, no data are available on the role of dietary carbohydrates on gallbladder wall fat and inflammation. Therefore, we tested the hypothesis that both obesity and dietary carbohydrates would increase gallbladder fat and cytokines, steatocholecystitis.

METHODS

At 8 wk of age, 47 lean and 22 obese female mice were fed a 45% carbohydrate (CHO) diet while an equal number of lean and obese mice were fed a 75% CHO diet for 4 wk. All mice underwent cholecystectomy, and the gallbladders were snap-frozen. Individual and total lipids were measured by gas chromatography. Interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha, and IL-6 were measured by enzyme-linked immunosorbent assay. Data were analyzed by analysis of variance and Tukey test.

RESULTS

Gallbladder total fat, triglycerides, and cholesterol were maximum (P < 0.001) in obese mice on the 75% CHO diet. Gallbladder TNF-alpha and IL-1beta as well as serum cholesterol levels showed a similar pattern (P < 0.001). Gallbladder saturated free fatty acids and IL-6 levels were highest (P < 0.001) in obese mice on the 45% CHO diet.

CONCLUSIONS

These data suggest that (1) both obesity and dietary carbohydrates increase gallbladder total fat, triglycerides, cholesterol, TNF-alpha, and IL-1beta and (2) obesity also increases gallbladder free fatty acids and IL-6. Therefore, we conclude that obesity is associated with steatocholecystitis and that a high carbohydrate diet exacerbates this phenomenon.