Nutrition and cholesterol gallstones

Dietary fiber intake and risk of gallstone: a case-control study

BACKGROUND

Gallstone disease (GSD) and its complications are major public health issues globally. Although many community-based studies had addressed the risk factors for GSD, little is known about the associations between dietary factors and risk of disease. The present study aimed to investigate the potential associations between dietary fibers with the risk of gallstone disease.

METHODS

In this case-control study, 189 GSD patients with less than one month of diagnosis and 342 age‑matched controls were enrolled. Dietary intakes were assessed using a 168-item semi-quantitative validated food frequency questionnaire. Crude and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models.

RESULTS

Comparing the highest versus the lowest tertile, significant reverse associations were observed between odds of GSD and each category of dietary fiber intake including total (OR _{T3 vs. T1} = 0.44, 95% CI: 0.37-0.7, P for trend = 0.015), soluble (OR _{T3 vs. T1} = 0.51, 95% CI: 0.3-0.8, P for trend = 0.048) and insoluble (OR _{T3 vs. T1} = 0.56, 95% CI: 0.3-0.9, P for trend < 0.001). The relationship between dietary fiber intake and the risk of gallstones was more prominent in overweight and obese subjects than in subjects with a normal body mass index.

CONCLUSION

Comprehensive assessment of the associations of dietary fiber intake with GSD showed that higher intakes of dietary fiber were significantly associated with reduced GSD risk.

A Predictive Model for the Risk of Cognitive Impairment in Patients with Gallstones

OBJECTIVES

Gallstones can cause malnutrition in patients and further lead to cognitive impairment. This study is aimed at constructing a validated clinical prediction model for evaluating the risk of developing cognitive impairment from gallstones.

METHODS

The study was a single-centre crosssectional study. Four models or methods (SVM-RFE, random forest model, Lasso model, and logistics analysis) were analyzed and compared regarding their predictive performance. The model with the best classification performance and predictive power was selected. The AUC index, C-index, and calibration curves were applied to the chosen model to further evaluate its classification and prediction performance. Finally, the nomogram was plotted, and the clinical usability, efficacy, and safety of the nomogram were assessed using decision curve analysis (DCA).

RESULTS

This study included a total of 294 patients with gallstones, of which 110 had cognitive impairment. Factors such as gender, age, education, place of birth, history of alcohol consumption, abdominal circumference, sarcopenia, diabetes, anaemia, depression, and Pittsburgh Sleep Quality Index (PSQI) were incorporated into the model for nomogram construction. The calibration curve showed that the nomogram had good classification performance. Furthermore, the C-index of the model was 0.778 (95% CI, 0.674-0.882) in the test group. The DCA curves indicated that the constructed model had strong clinical applicability, efficacy, and safety.

CONCLUSIONS

This study constructed a cognitive impairment risk prediction model for patients with gallstones with good classification and predictive power. The constructed predictive model allows us to screen patients with gallstones and at high risk of cognitive impairment. These efforts might also help to further increase patient compliance, assist healthcare professionals to better manage patients with gallstones, and ultimately improve their overall health status and quality of life. Future clinical studies should further evaluate the accuracy and clinical usability of this model.

Diet as a risk factor for cholesterol gallstone disease

Cholesterol gallstone disease is a common condition in western populations. The etiology is multifactorial with interaction of genetic and environmental factors. Obesity, aging, estrogen treatment, pregnancy and diabetes are consistently associated to a higher risk. A number of dietary factors have been involved in the pathogenesis of cholelithiasis. In this article we summarize several studies that have evaluated the role of diet as a potential risk factor for gallstone formation, including energy intake, cholesterol, fatty acids, fiber, carbohydrates, vitamins and minerals, and alcohol intake. Consumption of simple sugars and saturated fat has been mostly associated to a higher risk, while fiber intake and moderate consumption of alcohol, consistently reduce the risk. The association between cholesterol intake and gallstone disease has been variable in different studies. The effects of other dietary factors are less conclusive; additional studies are therefore necessary to clarify their relevance in the pathogenesis of gallstone disease. Recent discoveries of the role of orphan nuclear receptors in the regulation of fatty acid and hepatic cholesterol metabolism and excretion open new perspectives for a better understanding of the role of dietary constituents on cholesterol gallstone formation. KEY TEACHING POINTS: The etiology of cholesterol gallstone disease is multifactorial with interaction between genome and environment. It has been postulated that dietary constituents are important determinants for the formation of lithogenic bile. Intake of high energy, simple sugar and saturated fat favors gallstone formation. Fiber and moderate consumption of alcohol reduce the risk. The role of orphan nuclear receptors in the regulation of hepatic cholesterol metabolism and excretion open new leads for understanding the role of dietary constituents on cholesterol gallstone formation.

Soy isoflavones improve plasma lipids in normocholesterolemic, premenopausal women

BACKGROUND

Soy consumption is known to reduce plasma total cholesterol and LDL cholesterol in hypercholesterolemic subjects, but the responsible soy components and the effects in normocholesterolemic subjects remain unclear.

OBJECTIVE

The effects of soy isoflavone consumption on plasma total cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerol, apolipoprotein A-I, apolipoprotein B, and lipoprotein(a) concentrations and on LDL peak particle diameter were examined in normocholesterolemic, premenopausal women.

DESIGN

Thirteen healthy, normocholesterolemic, free-living, premenopausal female volunteers took part in this randomized, crossover-controlled trial. Each subject acted as her own control. Three soy isoflavone intakes (control: 10.0 +/- 1.1; low: 64.7 +/- 9.4; and high: 128.7 +/- 15.7 mg/d), provided as soy protein isolate, were consumed for 3 menstrual cycles each. Total cholesterol, HDL cholesterol, LDL cholesterol, and triacylglycerol were measured over the menstrual cycle. Apolipoprotein A-I, apolipoprotein B, lipoprotein(a), and LDL peak particle diameter were evaluated in the midluteal phase.

RESULTS

Total cholesterol, HDL-cholesterol, and LDL-cholesterol concentrations changed significantly across menstrual cycle phases (P < 0.005). During specific phases of the cycle, the high-isoflavone diet lowered LDL cholesterol by 7.6-10.0% (P < 0.05), the ratio of total cholesterol to HDL cholesterol by 10.2% (P < 0.005), and the ratio of LDL to HDL cholesterol by 13.8% (P < 0.002).

CONCLUSIONS

Isoflavones significantly improved the lipid profile across the menstrual cycle in normocholesterolemic, premenopausal women. Although of small magnitude, these effects could contribute to a lower risk of developing coronary heart disease in healthy people who consume soy over many years.

Dietary intake and gallbladder disease: a review

OBJECTIVE

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.

DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

Dietary fat alters biliary lipid secretion in the hamster

Dietary fat has been found to alter the incidence of cholesterol gallstones in hamsters: butterfat intensifies while safflower oil reduces lithiasis. WE not report how dietary fat affects bile flow and biliary lipid secretion in this model. Male hamsters were fed one of three experimental diets: a control diet (containing 0.3% cholesterol); control diet + 4.0% butterfat; or control diet + 4.0% safflower oil. After three weeks, bile samples were collected via an external biliary fistula. The endogenous bile acid pool was depleted for 120 min followed by increasing rates of taurocholate infusion for 160 min. Basal secretion of biliary lipids was measured during the bile acid depletion period. Basal bile flow and bile acid output were not significantly different in the three groups. Dietary butterfat increased basal cholesterol output compared to the control diet (0.037 vs. 0.025 mumol/min.kg, respectively); safflower oil did not change cholesterol output (0.027 mumol/min.kg). Hamsters fed butterfat or safflower oil secreted more phospholipid (0.171 and 0.178 mumol/min.kg, respectively) than controls (0.131 mumol/min.kg). The cholesterol/phospholipid output ratio of the butterfat group was higher than the safflower oil group (0.220 vs. 0.153, respectively). Effects of dietary fat on several relationships between file flow and biliary lipid secretion were analyzed by linear regression using the data for the entire bile collection period (bile acid depletion and taurocholate infusion). Butterfat and safflower oil did not change either bile acid dependent or bile acid independent bile flow. Hamsters fed butterfat had a higher linkage coefficient (slope) of cholesterol vs. bile acid output than the safflower oil group (0.023 vs. 0.009, respectively). The linkage coefficient of phospholipid vs. bile acid output of the butterfat group was higher than the controls (0.278 vs. 0.185, respectively). In summary, butterfat induced a high cholesterol and phospholipid secretion with a high cholesterol/phospholipid output ratio; safflower oil induced a high phospholipid secretion with a low cholesterol/phospholipid output ratio. Butterfat and safflower oil have different effects on biliary lipid secretion. These differences in biliary lipid secretion may explain, in part, how butterfat and safflower oil differ in affecting gallstone formation in hamsters.

High fat diet and liver damage induced by biliary obstruction in the rat

There is a great body of evidence linking a high fat diet with the formation of gallstones. However, the effect of fat per se on obstructive liver damage (not involving gallstone formation) has not been assessed. The aim of this work was to study the effect of a high fat diet on liver damage induced by bile duct ligation in rats. Male 21-day-old Wistar rats were divided into two groups: group 1 received standard Purina chow diet 5001 containing 4.5% fat, group 2 received Purina chow diet 5001 enriched with 33% pork fat. Animals were allowed food and water ad libitum for 5 weeks. Obstructive jaundice was induced by double ligation and division of the common bile duct. The animals were sacrificed 1 week after biliary obstruction. Control animals were sham operated. Serum bilirubins and alkaline phosphatase, gamma-glutamyl transpeptidase and glutamic pyruvic transminase enzyme activities increased by biliary obstruction. Glycogen content decreased in the bile duct-ligated rats. These effects were more important in the group fed a 33% fat diet. Our results show that a high animal fat diet increases liver damage in experimental biliary obstruction in rats. Owing to our experimental design (bile duct ligation), the effect of a high fat diet cannot be attributed to an increase in the formation of gallstones but a direct effect must be considered. The mechanism by which fat augmented liver damage can be associated with an increase of total bile content and its toxicity.

A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting

BACKGROUND

Dietary risk factors for the development of gallstones have not been clearly established. We analyzed data from a population-based prospective study to determine dietary risk factors for hospitalization with gallstone disease.

METHODS

We evaluated the role of dietary constituents, fasting, and dieting on subsequent hospitalization with gallstone disease among 4,730 women, ages 25 to 74 years, who participated in the first follow-up of the first National Health and Nutrition Examination Survey. Baseline dietary variables were established through a 24-hour dietary recall and a medical history. Proportional hazards models were used to calculate the effects of dietary variables while controlling for baseline risk factors.

RESULTS

After an average of 10 years follow-up, gallstone disease was confirmed by hospital records among 216 women who denied gallstone disease at the baseline examination. The hazard rate of hospitalization with gallstone disease increased with increasing overnight fasting period and with dieting. Intake of fiber showed a small protective effect. The effect of energy intake was significant only among women younger than age 50 years at baseline. Results were not affected by adjustment for known risk factors for gallstone disease or other dietary factors.

CONCLUSION

A long overnight fasting period, dieting, and low fiber intake may increase the risk of hospitalization with gallstone disease.

Coronary risk factors and clinical gallbladder disease: an approach to the prevention of gallstones?

We examined the relationship of "coronary" risk factors to clinical gallbladder disease prevalence in a cross-sectional survey. Persons with hypercholesterolemia, hypertriglyceridemia, or low high-density-lipoprotein cholesterol levels had elevated risks for clinical gallbladder disease. Smokers of 20 pack-years or more and infrequent users of alcohol had increased risks, as did persons with hypertension or diabetes mellitus. After adjusting for age, body mass index, ethnicity, and the coronary variables, relationships persisted for diabetes in women (OR = 1.8) and frequent alcohol use in men (OR = 0.3). The proportion of gallbladder disease related to all coronary risk factors was estimated to be 52 per cent.