Prevalence of hyperlipoproteinemia in men with gallstone disease

Gallbladder motility in obesity, diabetes mellitus and coeliac disease

We reviewed data on gallbladder motility in obesity, diabetes and coeliac disease. In obesity, a condition characterised by increased risk of gallstone(s), decreased gallbladder motility has heterogeneously been reported as a consequence of the different type of meals used to induce gallbladder contraction, characteristics of the population studied, technique used, and proportion of patients with hyperinsulinaemia. Moreover, recent studies have evaluated the effect of dietary restriction on gallbladder motility in obese patients. A two- to three-fold increase in the risk of cholesterol gallstone(s) has been reported in diabetic patients, mainly in relation to obesity and hypertriglyceridaemia. Furthermore, decreased gallbladder motility has been described and attributed to other factors, including underlying autonomic neuropathy, reduced gallbladder sensitivity to cholecystokinin and/or reduced number of cholecystokinin receptors on the gallbladder wall. Impaired gallbladder motility has been reported also in patients with coeliac disease in relation to reduced secretion of enteric hormones and/or decreased gallbladder sensitivity to them. In particular, untreated coeliacs, when compared to controls, showed low postprandial cholecystokinin and increased fasting somatostatin levels. Interestingly, the correlation between fasting somatostatin levels and gallbladder size has clearly been confirmed in patients affected by somatostatinoma or treated with somatostatin or its analogues. Gallbladder motility can be affected by various clinical conditions, such as obesity, diabetes mellitus and coeliac disease.

Prevalence of gallstone disease in Iran

BACKGROUND

Prevalence of gallstone disease is different depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. The aim of this study is to examine the prevalence of gallstone disease in Iran.

METHODS

Four hundred and seventy-seven nomads from southern Iran, 513 industrial laborers older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography.

RESULTS

There were 1373 men and 509 women. Eighty-nine subjects had gallstone disease and 10.1% of them were cholecystectomized. While the prevalence in the men and women in the age group 31-40 years was very low (0.3% in men and 1.8% in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10-fold (12.5 and 24.6% in male and female with an age 71-80 years, respectively).

CONCLUSION

In Iran, gallstone disease is very uncommon in middle-aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber-containing diet, a low number of overweight people, smoking habit and hyperlipidemia are probably the cause for this low prevalence.

Serum lipids and gallstone disease. A study of self-defense officials in Japan

Based on screening ultrasonography of the gallbladder in 2756 men who received a retirement health examination at the Self-Defense Forces Fukuoka Hospital, Japan, during the period of 1986 to 1990, we compared serum lipid levels among 61 men with gallstones, 38 who had the gallbladder removed previously, and 2494 with a normal gallbladder. In univariate analysis, men having gallstones and those who had had a cholecystectomy had lower concentrations of total and low-density-lipoprotein (LDL) cholesterol than did control subjects, although the differences were not statistically significant. After adjustment for body mass index, smoking, alcohol use, and glucose tolerance, inverse associations of cholecystectomy with total and LDL cholesterol levels were more pronounced and statistically significant. There was no appreciable difference in high-density-lipoprotein (HDL) cholesterol and triglycerides between control subjects and men either with gallstones or after cholecystectomy. The present study did not support a positive relation between gallstones and serum triglyceride levels and an inverse one to HDL cholesterol, which have been reported elsewhere. The findings on total and LDL cholesterol are consistent with some, but not all recent studies.

Diet-induced type IV-like hyperlipidemia and increased body weight are associated with cholesterol gallstones in hamsters

Male Syrian hamsters (60-70 g) were fed purified diets containing 5% fat (American Fat Blend) and 15% fiber with or without 0.3% cholesterol (0.86 mg/kcal), for 12 weeks. Hamsters fed the cholesterol-supplemented challenge diet revealed a major increase in plasma triglyceride between 9 and 12 weeks, whereas plasma cholesterol (which reflected body weight dynamics) increased three-fold up to nine weeks and plateaued (342 +/- 22 vs. 122 +/- 5 mg/dL). The greatest increases in cholesterol occurred in the very low density lipoprotein (VLDL) and high density lipoprotein (HDL2) fractions. Gallstone incidence was similar (69% vs. 78%) for cholesterol-supplemented vs. control hamsters, but the type of stones differed. Of the cholesterol-supplemented hamsters with gallstones, 45% had cholesterol stones and 55% had pigment stones. Only pigment stones were seen in control hamsters. Hamsters with cholesterol stones were 25% heavier and transported most cholesterol in VLDL (33 +/- 5%), approximately double that in VLDL of cholesterol-supplemented hamsters with no stones (19 +/- 3%) or cholesterol-supplemented hamsters with pigment stones (21 +/- 3%). Hamsters with pigment stones or no stones (regardless of diet fed) transported the majority of their cholesterol in HDL2 (44%), whereas this figure was only 27% in hamsters that developed cholesterol stones. Thus pigment stones develop routinely in hamsters fed casein-based purified diets. Adding dietary cholesterol resulted in cholesterol gallstones only in those hamsters that gained the most weight and whose terminal VLDL/HDL cholesterol ratio exceeded 1.0, not unlike the lipoprotein profile of obese humans who develop cholesterol gallstones.

One gram of aspirin per day does not reduce risk of hospitalization for gallstone disease

Data from 4524 patients in a randomized, controlled trial of aspirin were analyzed to determine if aspirin reduced the risk for hospitalization for gallstone disease. Aspirin at a dose of 1000 mg/day did not reduce the risk of hospitalization for gallstones. Hospitalization rates for gallstone disease were consistent with national rates, and the data confirmed previous associations of gallstone disease with age, elevated serum triglycerides, obesity, and female gender.

Serum lipids and gallstones: a case-control study

The role of serum lipids in the etiology of cholesterol gallstones and pigment gallstones was assessed in a case-control study. The study included 250 cases with surgically or ultrasonographically confirmed cholecystolithiasis and 526 hospital control patients. The highest gallstone risk was found at low high-density cholesterol levels and high triglyceride levels. An additional weakly negative association was found between total cholesterol level and gallstone risk. These findings were similar for cholesterol gallstones and pigment gallstones. The association between body mass index and gallstone risk disappeared after adjustment for serum lipids in a multivariate analysis. This study confirms previous reports on the association between gallstone risk and serum lipids. The similarity between cholesterol and pigment gallstones with regard to their association with serum lipids indicates that these types of gallstones share more causal factors than previously suggested. The absence of an effect of body mass index independent from serum lipids (as shown by the multivariate analysis) suggests that serum lipids are more closely linked to the pathogenesis of gallstones than obesity.

Gallstones, serum lipids, and glucose tolerance among male officials of Self-Defense Forces in Japan

The relationships of gallstones and the postcholecystectomy state with serum total cholesterol, serum triglycerides, glucose tolerance, and obesity were examined in male officials of the Self-Defense Forces in northern Kyushu, Japan. The study population had rather low rates of gallstones (2%) and prior cholecystectomy (3%). A strong relationship between obesity and gallstones was confirmed. Glucose intolerance was associated with the risk of gallstones independent of obesity. No relation between gallstones and either serum total cholesterol or triglycerides after adjustment for obesity and glucose tolerance was evident. However, the serum concentration of total cholesterol among men having had a cholecystectomy was less than that of those without gallstones.

Plasma lipids and insulin in gall stone disease: a case-control study

Fasting plasma lipid and insulin concentrations were measured in 173 patients with gall stones and 284 hospital controls to investigate their relationship to this disease. Multivariate methods of analysis were used to estimate the net associations between individual plasma variables and the risk of developing gall stones. In both sexes increased plasma insulin values were associated with an increased risk of gall stones independently of plasma triglyceride values; increased plasma triglyceride concentrations were associated with an increased risk of gall stones in young subjects only; increased plasma total cholesterol concentrations were associated with a decreased risk of gall stones only after controlling for plasma insulin and triglyceride concentrations; while increased plasma high density lipoprotein cholesterol concentrations were associated with a decreased risk of gall stones, but were confounded by plasma insulin and triglyceride values. These associations were independent of obesity and dietary intake.

[Relation between serum lipoprotein metabolism and biliary lipid metabolism]

This review concern with recent results regarding interrelationships between serum lipoprotein and bile acid metabolism. First, changes in bile acid metabolism in primary hyperlipoproteinaemia type II and type IV are described. In addition, influences of lipid-lowering drugs such as sitosterol, cholestyramine/colestipol, neomycin, nicotinic acid, clofibrate and thyroxin on serum lipoproteins and biliary lipid metabolism are discussed. Changes in lipoprotein metabolism in disorders of bile acid metabolism and effects of primary and secundary bile acids on lipoprotein metabolism, hepatic cholesterol metabolism and intestinal cholesterol absorption are described. In the final discussion interrelationships between very low density lipoprotein - triglycerides and cholic acid metabolism as well as low density lipoprotein and chenodeoxycholic acid metabolism are stressed. The positive correlation between serum triglycerides and lithogenicity of bile is underlined and the possible significance of high density lipoprotein-cholesterol as precursor of biliary cholesterol is discussed.

Bile acid content of gallbladder bile and stones in type IIb and IV hyperlipoproteinemia

We examined the bile acid composition of gallbladder bile using reversed-phase high performance liquid chromatography (HPLC), in normolipemic and hyperlipidemic (types IIb and IV) patients with cholelithiasis and compared them with normal subjects. Similarly, bile acid composition was determined n the gallstones of these patients. No free bile acids were found in any of the samples examined. We observed that gallbladder bile and gallstones of patients with type IV hyperlipidemia showed a significant increase in the percentage of glyco-conjugated bile acids and reduction in taurine conjugates. Based on this finding we postulate that in addition to biliary lipid composition bile acid composition may also play a role in the pathogenesis of cholesterol gallstone formation.

An analysis of data on human hepatic bile. Relationship between main bile components, serum cholesterol and serum triglycerides

Hepatic bile samples were taken from the common duct during interval operations for gallstone disease, performed under standardized conditions. Prior to operation serum cholesterol and triglycerides levels were determined. The concentrations of Cholesterol (Chol), phospholipids (Lip P) and of the three major bile acids (BA) were determined in ninety-seven samples. The data were subjected to statistical analysis. A highly significant rank correlation was found between the Chol- and the Lip P molar fractions. The rank correlation between the Chol molar fraction and the BA/Lip P ratio was highly significantly negative. Reasons are given why the observed intraindividual differences are interpreted as reflecting interindividual changes. The conclusion is that just as in the animal model, a rise of Chol in human hepatic bile is accompanied by a decrease of the BA/Lip P ratio. A significant correlation was found between chenodeoxycholic acid (CDCA), and the ratio between the two other main bile acids (CA/DCA). High lithogenicity was associated with low CDCA- and high DCA values. In a mathematical representation valid in the sense of a rank correlation, the bile/serum Chol ratio rose with increasing DCA values combined with increasing absolute differences between the other acids. Serum triglycerides were negatively correlated with the BA molar fraction and with the absolute concentration of BA. As a result there was an association between serum triglycerides and lithogenicity.