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PubMed2002

Hyperinsulinemia, dyslipidemia, and obesity as risk factors for hospitalized gallbladder disease. A prospective study.

PURPOSE: Prospective studies of gallbladder disease have investigated a limited number of risk factors and have been conducted predominantly in women. Determinants of hospitalized gallbladder disease were examined in a large, population-based cohort of men and women. METHODS: Subjects, aged 45-64 years, were participants in the Atherosclerosis Risk in Communities (ARIC) Study who reported no history of gallbladder disease at baseline (n = 12,773). Incident cases of gallbladder disease were identified through surveillance of hospital discharges between the baseline visit (1987-1989) and 1996. RESULTS: The crude incidence rate of hospitalized gallbladder disease was 3.8 per 1000 person-years. In women, increasing risk was observed for increasing levels of body-mass index and waist-to-hip ratio, whereas in men, increased risk was observed only in the morbidly obese (BMI >or= 35). Fasting serum insulin, low HDL cholesterol, elevated triglycerides, and hormone replacement therapy were all positively associated with gallbladder disease risk. The relative risks associated with having one, two, or three or more components of the "multiple metabolic syndrome" in men were 1.45 (95% CI = 0.9-2.3), 2.17 (1.3-3.6), and 2.34 (1.3-4.3), respectively. CONCLUSIONS: In men, hyperinsulinemia and dyslipidemia may have some role in the etiology of gallbladder disease beyond their association with obesity, whereas in women, increased body size, central adiposity, and hormone replacement therapy may be more important determinants of gallbladder disease.

Age Factors↗

PubMed2000

Association of diabetes, serum insulin, and C-peptide with gallbladder disease.

An inconsistent association has been found between gallbladder disease and diabetes mellitus. We hypothesized that insulin resistance rather than diabetes status may be a primary factor involved in gallstone formation. A total of 5,653 adult participants in the third United States National Health and Nutrition Examination Survey without known diabetes underwent gallbladder ultrasonography and phlebotomy after an overnight fast for measurement of serum insulin, C-peptide, and glucose. Gallbladder disease was defined as ultrasound-documented gallstones or evidence of cholecystectomy. Subjects were characterized as having normal fasting glucose (<110 mg/dL), impaired fasting glucose (110 to <126 mg/dL), or undiagnosed diabetes (>/=126 mg/dL). After controlling for other known gallbladder disease risk factors, among women, undiagnosed diabetes was associated with increased risk of gallbladder disease (prevalence ratio [PR] = 1.91, 95% confidence interval [CI] = 1.29-2. 83); whereas impaired fasting glucose was unassociated. Gallbladder disease risk in women increased with levels of fasting insulin (PR = 1.63, 95% CI = 1.11-2.40) and C-peptide (PR = 2.07, 95% CI = 1.32-3. 25) comparing highest to lowest quintiles. However, the association of gallbladder disease with undiagnosed diabetes was not diminished when the model included fasting insulin (PR = 1.85, 95% CI = 1.24-2. 77). In men, there was a statistically nonsignificant association with undiagnosed diabetes (PR = 2.11, 95% CI = 0.76-5.85), but no association of gallbladder disease with insulin or C-peptide. Among women higher fasting serum insulin levels increased the risk of gallbladder disease, but did not account for the increased risk in persons with diabetes.

Adult↗

PubMed1990

Low incidence of hospitalization with gallbladder disease among blacks in the United States.

Low rates of gallbladder disease among blacks have been reported but not systematically studied. The authors investigated the rate of hospitalization with a diagnosis of gallbladder disease in the follow-up in 1982-1984 of the first National Health and Nutrition Examination Survey, a population-based study conducted across the United States in 1971-1975. Based on hospital discharge diagnoses of gallbladder disease, 368 cases were identified for the period 1971-1984 among 10,551 persons, aged 25-74 years, who denied gallbladder disease at the baseline examination. The crude incidence of gallbladder disease per 1,000 person-years was 2.59 for white men, 1.45 for black men, 4.09 for white women, and 2.35 for black women. Controlling for obesity, parity, ethanol consumption, use of diuretics, use of oral contraceptives, and two indicators of socioeconomic status, the authors found that the hazard rate of hospitalization with gallbladder disease increased with age for white women and decreased for black women. The hazard ratio for black women compared with white women at 30 years of age was 0.71 with a 95% confidence interval of 0.52-0.96, but at age 70, it was 0.18 with a 95% confidence interval of 0.09-0.37. For women, obesity and parity were important risk factors for gallbladder disease (p less than or equal to 0.001), and the use of diuretics was marginally associated (p = 0.08). Black men compared with white men had a hazard rate of gallbladder disease of 0.53 with a 95% confidence interval of 0.24-1.16. For men, increasing age was related to gallbladder disease (p less than 0.001), and obesity was weakly related (p = 0.06). The black/white hazard ratios decreased further when controlling for socioeconomic status, persisted if the study population was limited to those hospitalized during follow-up, and increased slightly for cases with an acute complication of gallbladder disease. Thus, differential access to medical care may not explain the lower rate among blacks.

Adult↗

PubMedDate not supplied

Contrast-enhanced power Doppler US: is it useful in the differentiation of gallbladder disease?

Thirteen patients with gallbladder disease underwent power Doppler ultrasound (PDUS) before and after microbubble contrast agent injection. Lesion and liver bed vascularity was evaluated. Pathological diagnoses in nine patients were two acute cholecystitis, four chronic inflammation, one adenoma and two adenocarcinoma. Two cases of cancer were included on clinical and radiological findings. Two cases were excluded because no pathologic diagnosis was available. Liver bed hyperemia was noted only in acute cholecystitis. Contrast-enhanced PDUS was superior to nonenhanced PDUS in the demonstration of vascularity of gallbladder diseases. However, contrast-enhanced PDUS has limited value in the differentiation.

Adenocarcinoma↗

PubMed1986

Individual admixture estimates: disease associations and individual risk of diabetes and gallbladder disease among Mexican-Americans in Starr County, Texas.

The ethnic and geographic distributions of several common chronic diseases show distinct patterns that are consistent with the distribution of genes and genetic admixture. For example, diabetes and gallbladder disease occur most frequently among Amerindians, while those genetically admixed with them (such as Mexican-Americans) have intermediate rates, and lowest rates are found among Whites and Blacks. Because there will be heterogeneity from individual to individual in ancestral affinity within an admixed population, a method is developed for estimating each person's admixture probability. Results confirm that there is substantial heterogeneity of individual admixture among Mexican-Americans in Starr County, Texas, with a mean value indicating that 65% of genes in this population are Caucasian derived and 35% Amerindian derived. The individual estimates are shown to be unrelated to the probability of being diabetic and only marginally related to gallbladder disease, with those having the most Amerindian affinity being at increased risk. These results are a consequence of the independent assortment of loci and indicate that unless the markers employed are related (including linkage) to the disease of interest, the method will have limited utility. Individual admixture estimates will be useful, however, for examining aspects of population structure and will find increased utility for predicting disease and examining disease associations as more and more of the genome is represented by markers, a very probable prospect with the abundance of DNA polymorphism being identified by restriction enzymes.

Adolescent↗

PubMed1985

Socioeconomic status and the prevalence of clinical gallbladder disease.

The prevalence of clinical gallbladder disease was determined in a cross-sectional survey of Mexican Americans and non-Hispanic whites. The study population was randomly selected from three urban neighborhoods representing different socioeconomic strata. Gallbladder disease was defined as a history of cholecystectomy, or of stones on cholecystography. Mexican American women had an age-standardized prevalence of 16.9%, vs 8.7% for non-Hispanic whites (p less than 0.0001). Prevalences in men were 4.2 and 3.4%, respectively. The ethnic differences in women persisted after stratification by age, parity, and body mass index. Gallbladder disease prevalence was inversely related to four measures of socioeconomic status. After controlling for age, obesity, parity, and ethnicity, the prevalence in women was inversely related to levels of education, income, occupational status, and neighborhood. These socioeconomic differences, if not the result of detection bias, suggest that environmental factors may play a role in gallstone pathogenesis. Identification of such factors may lead to the development of preventive strategies.

Adult↗

PubMed1985

Gallbladder disease epidemiology in Mexican Americans in Starr County, Texas.

The prevalence of gallbladder disease (surgery or complaints) among Mexican Americans in Starr County, Texas, is demonstrated to be some threefold higher than in Framingham, with 13% and 26% of males and females, respectively, over the age of 35 years having the disease. The population aggregation of gallbladder disease in Amerindian groups and those genetically admixed with them (as the present case) is consistent with an underlying genetic mechanism which is further substantiated here by examining relative risks in sibs, offspring, and spouses of individuals with gallbladder disease. It is shown that in females under the age of 45 years, there is evidence for a significant association between gallbladder disease and diabetes beyond that which could be explained by body mass. Significant gallbladder disease by nonlinear age interaction effects was detected for serum cholesterol. The predicted regression lines of cholesterol by age were uniformly lower for individuals with gallbladder disease than those without it except for ages 40-55 years, in which the lines were equal. When coupled with previous results on diabetes, the results presented document the extent to which diabetes and gallbladder disease dominate the health status of Mexican Americans in southern Texas and likely elsewhere.

Adolescent↗

PubMed2001

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.

Adipose Tissue↗

PubMed1983

Ultrasonographic findings in peptic ulcer disease and pancreatitis that simulate primary gallbladder disease.

The ultrasonographic findings in two patients with peptic ulcer disease and one patient with acute pancreatitis are reported. In each case, the sonographic appearance simulated intrinsic gallbladder disease. Two patients had focal pericholecystic fluid collections and one had an inflammatory mass adjacent to the gallbladder. Each patient also demonstrated gallbladder wall thickening. Findings of a pericholecystic fluid collection or an inflammatory mass adjacent to the gallbladder appear to be nonspecific for cholecystitis, and should also suggest inflammation of adjacent organs.

Acute Disease↗

PubMed2003

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.

Acupuncture↗

PubMed2000

Association of coffee consumption with gallbladder disease.

Coffee consumption was recently shown to protect against symptomatic gallbladder disease in men. The authors examined the relation of ultrasound-documented gallbladder disease with coffee drinking in 13,938 adult participants in the Third National Health and Nutrition Examination Survey, 1988-1994. The prevalence of total gallbladder disease was unrelated to coffee consumption in either men or women. However, among women a decreased prevalence of previously diagnosed gallbladder disease was found with increasing coffee drinking (p = 0.027). These findings do not support a protective effect of coffee consumption on total gallbladder disease, although coffee may decrease the risk of symptomatic gallstones in women.

Adult↗

PubMed1989

Dietary intake and the prevalence of gallbladder disease in Mexican Americans.

Mexican Americans have a high prevalence of gallbladder disease. We examined the contribution of ethnic preferences in food intake to the risk of gallbladder disease in Mexican Americans and non-Hispanic whites. Participants in a population-based health survey were questioned about any history of gallbladder disease, and were interviewed to determine their dietary intake. After adjusting for age, body mass index, and ethnic group, we found that women with the highest intake of total fat and linoleic acid had reduced risks of gallbladder disease, although an opposite trend was observed in men. High levels of sucrose intake and low levels of cholesterol intake were associated with an increased risk for both sexes, but the odds ratios were not statistically significant. Although Mexican Americans and non-Hispanics differed in their intake of several nutrients, the elevated risk of gallbladder disease in Mexican American women was unchanged after ethnic differences in food intake were taken into account. Although the dietary preferences of Mexican Americans as reflected in 24-h diet recall interviews do not appear to explain their high prevalence of gallbladder disease, this finding should be interpreted with caution because of methodologic limitations in measuring habitual food intake.

Adult↗

PubMedDate not supplied

Intervention for gallbladder disease.

Intervention in the gallbladder includes therapy for both acute and chronic gallbladder disease. Although drainage for acute cholecystitis has been described by several investigators, the future seems to be in removal of calculi in symptomatic patients without acute cholecystitis. The technique for acute gallbladder drainage is described in detail using ultrasound guidance with or without fluoroscopy; for symptomatic gallstones, the clinical and technical aspects are described. We also discuss in detail the totally new concept for gallstone removal and the initial patient work using rotational contact lithotripsy with the Kensey-Nash device.

Cholelithiasis↗

PubMed1995

Gallbladder disease and the gynecologist.

Gallbladder disease continues to be a common problem for women. Diagnostic tools such as ultrasonography have allowed earlier and more accurate diagnoses to be made. Therapies have changed significantly in the past few years, and the new treatments are associated with lower morbidity than is the classic cholecystectomy. The gynecologist should be aware of evolving technologies to assist his or her patient in choosing the safest and most cost-effective therapies.

Adult↗

PubMed1990

Increased prevalence of clinical gallbladder disease in subjects with non-insulin-dependent diabetes mellitus.

The association between non-insulin-dependent diabetes mellitus (NIDDM) and the prevalence of gallbladder disease remains controversial. The authors investigated this association in 1,250 men and 1,656 women from the San Antonio Heart Study (1984-1988) a population-based study of diabetes and cardiovascular disease. A total of 68% of the subjects were Mexican American, a population at high risk for both gallbladder disease and NIDDM. Gallbladder disease was assessed by self-report, and the prevalence of diabetes was determined using National Diabetes Data Group criteria. NIDDM was significantly associated with gallbladder disease in Mexican-American men and women and in non-Hispanic white women. After adjustment for age, body mass index, ratio of waist-to-hip circumference, and ethnicity, using multiple logistic regression, the odds of gallbladder disease in women was 1.6 times higher if NIDDM was present (odds ratio = 1.60, 95% confidence interval 1.08-2.37). Mexican-American women also had a significantly increased prevalence of gallbladder disease relative to non-Hispanic white women (odds ratio = 2.21, 95% confidence interval 1.50-3.28). In nondiabetic women, fasting insulin was significantly related to prevalence of gallbladder disease in univariate analyses, but not in multivariate analyses. The authors conclude that women with diabetes have an increased prevalence of gallbladder disease relative to nondiabetic women and that this association is not explained by the greater adiposity or unfavorable body fat distribution of the diabetic subjects.

Adult↗

PubMed1979

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)].

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.

Acute Disease↗

PubMed1979

Prevalence of gallbladder disease in hyperlipoproteinemia.

An analysis of the occurrence of gallbladder disease (ie, cholelithiasis, cholecystitis, cholecystectomy) in 210 consecutive patients with primary hyperlipoproteinemia showed that the prevalence of gallbladder disease was 8%, 18%, and 42% in males with type IIa, IIb, and IV hyperlipoproteinemia, and 22%, 48%, and 72% in the corresponding groups of females. The 40-59-year-old patients were compared to three necropsy series from Malmö, Sweden. The occurrence of gallbladder disease was within normal limits in type IIa and abnormally high in type IV hyperlipoproteinemia. There were no differences with regard to age, body weight, glucose intolerance, or ischemic heart disease between type IV patients with and without GBD. It is suggested that certain forms of disturbances of lipoprotein metabolism are associated with an increased risk for development of gallbladder disease.

Adult↗

PubMed1977

Prevalence of gallstones and gallbladder disease in Canadian Micmac Indian women.

The prevalence of gallstones and gallbladder disease was studied between October 1973 and June 1976 in Canadian Micmac Indian women aged 15 to 50 years in an inland rural community near Shubenacadie, NS. Of 132 women at risk 98 underwent cholecystography, 6 had a history of cholecystectomy (verified from hospital records) and 3 had cholecystectomy because of cholecystitis during the 3 years of the study. Of the 17 abnormal cholecystograms 10 showed radiolucent gallstones, and repeated studies documented gallstones in 6 of the 7 radiographs on which the gallbladder was not visualized. The prevalence of gallstones was found to be 211/1000, and that of gallbladder disease, 240/1000. The peak prevalence was at 30 to 39 years of age. The women with gallbladder disease were significantly more obese and of greater parity than those without gallbladder disease even when age was controlled. The Micmac Indian women of Nova Scotia appear to be at a much higher risk for the development of cholesterol gallstones and gallbladder disease than Caucasian women in Framingham, Massachusetts.

Adolescent↗