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Mewa Kinoo S, Nagiah S, Chuturgoon A, Singh B. Symptomatic gallstones and HIV in black South African women: Changing trends of gallstone disease? South Afr J HIV Med 2021; 22:1208. [PMID: 33936792 PMCID: PMC8063772 DOI: 10.4102/sajhivmed.v22i1.1208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of metabolic disorders in human immunodeficiency virus (HIV) endemic settings is a prevailing burden in developing countries. Cholesterol homeostasis and fat metabolism are altered by HIV and antiretroviral therapy (ART), thereby possibly contributing to complications such as gallstone formation. OBJECTIVES The aim of this study was to evaluate established risk factors for the formation of cholesterol gallstones in black South African women living with HIV (WLHIV). METHOD A case series study was conducted of all black South African women undergoing cholecystectomy for gallstone disease over a 1-year period at King Edward VIII Hospital, Durban, South Africa. Age, body mass index (BMI), family history of gallstones, oestrogen exposure and lipograms were compared between WLHIV and uninfected women. Categorical variables were tested using either the Fisher's exact test or Pearson's chi-square test. Means were compared using independent t-tests. For non-normally distributed data, the Mann-Whitney U test was used. Statistical tests were two-sided, and p-values of less than 0.05 were considered statistically significant. RESULTS A total of 52 patients were assessed, 34 HIV-uninfected and 18 WLHIV. The median age of WLHIV versus the uninfected women was 35 and 50 years, respectively, (p = 0.015). A statistically significant number of uninfected women were in the overweight/obese category (BMI > 25 kg/m2) compared to the normal weight category (BMI < 25 kg/m2) (p < 0.001). The number of obese WLHIV did not reach statistical significance. CONCLUSION The age of occurrence of gallstone disease amongst black South African WLHIV was significantly lower and fewer women were obese compared with the uninfected women with gallstone disease. These findings differ from known gallstone risk factors in other populations and in uninfected black South African women. This could be attributed to the metabolic alterations caused by HIV infection itself and/or to the long-term use of ART. Larger cohort studies are required to elucidate the role of HIV and ART in cholestatic disease.
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Affiliation(s)
- Suman Mewa Kinoo
- Department of General Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Savania Nagiah
- Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University Missionvale, Port Elizabeth, South Africa
| | - Anil Chuturgoon
- Department of Medical Biochemistry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bhugwan Singh
- Department of General Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Affiliation(s)
- T. Jørgensen
- The Glostrup Population Studies, Dept. of Internal Medicine C, Glostrup Hospital, University of Copenhagen, and Dept. of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K. Hougaard Jensen
- The Glostrup Population Studies, Dept. of Internal Medicine C, Glostrup Hospital, University of Copenhagen, and Dept. of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Screen-detected gallstone disease and autoimmune diseases - A cohort study. Dig Liver Dis 2018; 50:594-600. [PMID: 29422240 DOI: 10.1016/j.dld.2018.01.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/23/2017] [Accepted: 01/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallstone disease is highly prevalent and is associated with systemic inflammation. AIMS To determine whether screen-detected gallstones or cholecystectomy are associated with the occurrence of autoimmune and autoinflammatory diseases and the most common subgroups thereof. METHODS A cohort study of three randomly selected general population samples from Copenhagen was performed. Participants (n = 5928) were examined in the period 1982-1992, underwent abdominal ultrasound examination to detect gallstone disease, and followed through national registers until December 2014 (median 24.7 years) for occurrence of immunological diseases. Multivariable Cox regression analyses were performed. RESULTS Gallstone disease was identified in 10% (591/5928) of participants, of whom 6.8% had gallstones and 3.2% had cholecystectomy at baseline. Gallstone disease was associated with incidence of autoimmune diseases (12.9% versus 7.92%; hazard ratio 1.46; 95% confidence interval [CI], [1.11;1.91]), diabetes mellitus type 1 (5.95% versus 3.67%; 1.53; [1.02;2.30]), and autoimmune thyroid disease (3.70% versus 1.59%; 2.06; [1.26;3.38]). Rheumatoid arthritis, autoinflammatory diseases, or any subgroups thereof were not associated. CONCLUSIONS In a large general population sample, screen-detected gallstone disease was associated with the development of autoimmune diseases during long-term follow-up. Future research efforts are needed to further explore common disease mechanisms.
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Shabanzadeh DM, Holmboe SA, Sørensen LT, Linneberg A, Andersson AM, Jørgensen T. Are incident gallstones associated to sex-dependent changes with age? A cohort study. Andrology 2017; 5:931-938. [DOI: 10.1111/andr.12391] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 05/09/2017] [Accepted: 05/13/2017] [Indexed: 12/22/2022]
Affiliation(s)
- D. M. Shabanzadeh
- Digestive Disease Center; Bispebjerg University Hospital; Copenhagen Denmark
- Research Centre for Prevention and Health; Centre for Health, Capital Region of Denmark; Glostrup Denmark
| | - S. A. Holmboe
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health; Rigshospitalet; Copenhagen Denmark
| | - L. T. Sørensen
- Digestive Disease Center; Bispebjerg University Hospital; Copenhagen Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - A. Linneberg
- Research Centre for Prevention and Health; Centre for Health, Capital Region of Denmark; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Clinical Experimental Research; Rigshospitalet; Glostrup Denmark
| | - A.-M. Andersson
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health; Rigshospitalet; Copenhagen Denmark
| | - T. Jørgensen
- Research Centre for Prevention and Health; Centre for Health, Capital Region of Denmark; Glostrup Denmark
- Department of Public Health; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- The Faculty of Medicine; Aalborg University; Aalborg Denmark
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Shabanzadeh DM, Skaaby T, Sørensen LT, Jørgensen T. Screen-detected gallstone disease and cardiovascular disease. Eur J Epidemiol 2017; 32:501-510. [PMID: 28551778 DOI: 10.1007/s10654-017-0263-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/21/2017] [Indexed: 12/21/2022]
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Shabanzadeh DM, Jørgensen T, Linneberg A, Sørensen LT, Skaaby T. Vitamin D and gallstone disease-A population-based study. Endocrine 2016; 54:818-825. [PMID: 27696253 DOI: 10.1007/s12020-016-1113-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/02/2016] [Indexed: 12/22/2022]
Abstract
Gallstone disease is highly prevalent in the general population and is a major gastrointestinal cause of hospital admissions. The objectives were to determine whether circulating levels of 25-hydroxyvitamin D were associated to ultrasound proven gallstones or cholecystectomy in a general population sample. Determinants of vitamin D status were also explored. A random sample of 4130 people from the population of Copenhagen with ages 41-71 years were invited (N = 4130) and 2650 participants were included. Ultrasound examinations were performed to assess gallstone status and blood samples were drawn to assess 25-hydroxyvitamin D and biomarkers of renal and hepatic function. Gallstone disease was found in 422 participants. Associations were estimated by logistic regression models. Levels of 25-hydroxyvitamin D was not significantly associated with gallstone disease. Time of birth during low vitamin D exposure was associated with gallstone disease (gallstone prevalence 18.0 versus 14.4 %, odds ratio 1.33, 95 % confidence interval [1.07; 1.65]). Highest quartile of cystatin C was significantly associated with gallstone disease (gallstone prevalence 22.1 versus 12.0 %, odds ratio 1.53, 95 % confidence interval [1.08; 2.18]). Serum levels of creatinine and alanine amino transferase were not associated with gallstone disease. Sensitivity analyses excluding participants with cholecystectomy did not alter results significantly. No association between 25-hydroxyvitamin D and gallstone disease was identified. Findings suggest gallstones to be associated to low vitamin D exposure in utero and to renal failure suggesting that vitamin D might have an impact on gallstone disease. Future studies should explore associations for vitamin D and gallstone disease prospectively.
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Affiliation(s)
- Daniel Mønsted Shabanzadeh
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark.
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark.
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
| | - Lars Tue Sørensen
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tea Skaaby
- Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
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Shabanzadeh DM, Sørensen LT, Jørgensen T. Gallstone disease and mortality: a cohort study. Int J Public Health 2016; 62:353-360. [PMID: 27815564 DOI: 10.1007/s00038-016-0916-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022] Open
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Shabanzadeh DM, Sørensen LT, Jørgensen T. Determinants for gallstone formation - a new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol 2016; 51:1239-48. [PMID: 27232657 DOI: 10.1080/00365521.2016.1182583] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Only few determinants of gallstone formation have been identified in cohort studies. The aim was to identify further determinants for gallstones in a Danish cohort and to perform a meta-analysis of results from existing cohorts. MATERIAL AND METHODS Data from a cohort study was used. Gallstone incidence was assessed through repeated ultrasound examinations. Body mass index (BMI), blood pressure, self-rated health, lifestyle variables, blood lipids, and use of female sex hormones were measured at the baseline examination. Statistical analyses included logistic regression. Based on a prospective protocol, a systematic review of the literature was performed identifying all articles dealing with determinants of incident gallstones. Meta-analyses of comparable determinants were performed through fixed effect models. RESULTS Participants with no gallstones at baseline and with at least one re-examination were followed-up completely (mean 11.6 years, N = 2848). The overall cumulative incidence of gallstones was 0.60% per year. Independent positive determinants for incident gallstones were age, female sex, non-high density lipoprotein (non-HDL) cholesterol, and gallbladder polyps. In addition, BMI was positively associated in men. The systematic review additionally identified associations for comorbidities, parity, and dietary factors. Meta-analysis confirmed the significant associations for incident gallstones and age, female sex, BMI, and non-HDL cholesterol. No significant associations were found for blood pressure, smoking, alcohol consumption, HDL cholesterol, or triglycerides in meta-analyses. CONCLUSIONS Age, female sex, BMI, non-HDL cholesterol, and polyps are independent determinants for gallstone formation. Incident gallstones and the metabolic syndrome share common risk factors. More studies are needed for further exploration.
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Affiliation(s)
- Daniel Mønsted Shabanzadeh
- a Digestive Disease Center , Bispebjerg University Hospital , Copenhagen , Denmark ;,b Research Centre for Prevention and Health , Centre for Health , Capital Region , Denmark
| | - Lars Tue Sørensen
- a Digestive Disease Center , Bispebjerg University Hospital , Copenhagen , Denmark ;,c Institute for Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Torben Jørgensen
- b Research Centre for Prevention and Health , Centre for Health , Capital Region , Denmark ;,d Department of Public Health, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark ;,e The Faculty of Medicine , Aalborg University , Aalborg , Denmark
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Abdominal Symptoms and Incident Gallstones in a Population Unaware of Gallstone Status. Can J Gastroenterol Hepatol 2016; 2016:9730687. [PMID: 27504440 PMCID: PMC4967696 DOI: 10.1155/2016/9730687] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/18/2016] [Accepted: 06/23/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction. Symptoms associated with newly formed gallstones have never been studied in a population unaware of their gallstones. The objective of this population-based cohort study was to determine which debut of abdominal symptoms was associated with newly formed gallstones. Materials and Methods. A cohort study was performed of a random sample from general population of Copenhagen. Participants had ultrasound examinations and answered questionnaires about abdominal symptoms at baseline and two reexaminations over 12 years. Participants were not informed of gallstone status. Inclusion criteria were no gallstones or cholecystectomy at baseline and attending a reexamination. Results. Of 3,785 participants, 2,845 fulfilled inclusion criteria. Changes in overall abdominal pain were not significantly different between incident gallstones or gallstone-free participants. Multiple adjusted logistic regression analyses showed that incident gallstones were significantly associated with debut of abdominal pain with projection, localized in the whole upper abdomen, and of longer duration. No significant associations for functional symptoms were identified. Conclusions. A new onset of abdominal pain with projection, localized in the whole upper abdomen, and of longer duration is associated with newly formed gallstones in participants unaware of gallstone status. Functional symptoms should not be the indication for surgical treatment.
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Abstract
Gallstone disease is one of the most prevalent gastrointestinal disorders. In addition, the costs associated with the diagnosis and treatment of gallstone disease have been rapidly increasing. The etiology and pathogenesis of gallstone disease remains incompletely understood. Gallstone formation may result from a complex interaction of genetic and environmental factors. This article reviews the prevalence and risk factors associated with gallstone disease. Understanding the pathogenesis of gallstone disease could lead to the development of better therapeutic and preventive strategies for dealing with this disease.
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Affiliation(s)
- Eun-Hyung Yoo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Boland LL, Folsom AR, Boerwinkle E. Apolipoprotein E genotype and gallbladder disease risk in a large population-based cohort. Ann Epidemiol 2006; 16:763-9. [PMID: 16882462 DOI: 10.1016/j.annepidem.2006.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 11/09/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the study is to describe the association between apolipoprotein E (apoE) genotype and gallbladder disease incidence. METHODS Cases of incident hospitalized gallbladder disease were ascertained in nearly 13,000 middle-aged men and women participating in the Atherosclerosis Risk in Communities (ARIC) Study, a prospective cohort study in four US communities. RESULTS Between the ARIC baseline examination (1987 to 1989) and December 31, 2001, a total of 639 participants were hospitalized for gallbladder disease. After adjustment for age, sex, race, obesity, plasma lipid level, and diabetes, the relative risk for hospitalized gallbladder disease associated with the presence of an epsilon4 allele (i.e., genotypes E4/4, E3/4, and E2/4 versus other genotypes) was 0.72 (95% confidence interval [CI], 0.60-0.87). Stratification by race showed that the inverse association with epsilon4 was stronger in whites (relative risk, 0.69; 95% CI, 0.56-0.85) than African Americans (relative risk, 0.86; 95% CI, 0.58-1.30). The presence of the other rare isoform, epsilon2 (i.e., genotypes E2/2, E2/3, and E2/4 versus others) was associated with a modest increased risk for gallbladder disease (relative risk, 1.28; 95% CI, 1.05-1.57). CONCLUSIONS These results suggest that independent of traditional risk factors, apoE genotype may influence gallbladder disease risk, particularly in whites. The exact biologic mechanism for such an association remains unclear and requires further investigation.
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Affiliation(s)
- Lori L Boland
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Walcher T, Haenle MM, Kron M, Hay B, Mason RA, von Schmiesing AFA, Imhof A, Koenig W, Kern P, Boehm BO, Kratzer W. Pregnancy is not a risk factor for gallstone disease: Results of a randomly selected population sample. World J Gastroenterol 2005; 11:6800-6. [PMID: 16425387 PMCID: PMC4725038 DOI: 10.3748/wjg.v11.i43.6800] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature.
METHODS: A total of 2 147 persons (1 111 females, age 42.8 ± 12.7 years; 1 036 males, age 42.3 ± 13.1 years) participating in an investigation on the prevalence of Echinococcus multilocularis were studied for risk factors and prevalence of gallbladder stone disease. Risk factors were assessed by means of a standardized interview and calculation of body mass index (BMI). A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package.
RESULTS: Gallbladder stones were detected in 171 study participants (8.0%, n = 2 147). Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy (yes/no) and number of pregnancies did not exert any influence.
CONCLUSION: Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies, however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations.
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Affiliation(s)
- Thomas Walcher
- University Hospital Ulm, Department of Internal Medicine I, Robert-Koch-Str. 8, D-89081 Ulm, Germany
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Attili AF, De Santis A, Attili F, Roda E, Festi D, Carulli N. Prevalence of gallstone disease in first-degree relatives of patients with cholelithiasis. World J Gastroenterol 2005; 11:6508-11. [PMID: 16425424 PMCID: PMC4355794 DOI: 10.3748/wjg.v11.i41.6508] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the influence of familiality on the prevalence of gallstone disease (GD) in Italy.
METHODS: Families of 79 subjects with gallstones (cases) and of 79 subjects without gallstones (controls) were investigated for the presence of gallstones by ultrasonography. Index cases and index controls were matched for age, sex, and operative unit. Sixty-three and sixty-two husbands and wives of index cases and index controls, respectively, were also studied.
RESULTS: Overall,the prevalence of GD was significantly higher ( χ2=14.52, P<0.001) in the 202 first-degree relatives of subjects with gallstones than that in the 201 first-degree relatives of subjects without gallstones (28.6% vs 12.4%, relative risk (RR) 1.80, 95% confidence interval (CI) 1.29-2.63). In particular, prevalence of GD was significantly higher in mothers, fathers, and sisters of index cases than that in the respective family members of index controls. The highest RR was observed in mothers (RR=2.35, 95%CI 1.38-4.3). Prevalence of GD was not obviously different in brothers and also in husbands and wives of index cases and index controls. Family members of index cases did not differ from family members of control cases with respect to the most important risk factors for gallstones (age, diabetes, BMI, and number of pregnancies) with an exception of a higher prevalence of diabetes in fathers of index controls than in fathers of index cases.
CONCLUSION: This study confirms that familiality plays a very important role in the pathogenesis of gallstones.
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Nakeeb A, Comuzzie AG, Martin L, Sonnenberg GE, Swartz-Basile D, Kissebah AH, Pitt HA. Gallstones: genetics versus environment. Ann Surg 2002; 235:842-9. [PMID: 12035041 PMCID: PMC1422514 DOI: 10.1097/00000658-200206000-00012] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine if a significant genetic component contributes to the pathogenesis of symptomatic gallstones. SUMMARY BACKGROUND DATA Gallstones represent a polygenic disorder that affects more than 30,000,000 Americans and results in more than 750,000 cholecystectomies in the United States annually. Risk factors include age, gender, race, parity, obesity, and diabetes. A family history of gallstones also has been identified as a risk factor suggesting that genetics play a role in gallstone formation. However, the role of genetics in the pathogenesis of gallstone formation has not been determined. METHODS A gallbladder disease-specific questionnaire was administered to 904 healthy unrelated adult volunteers (association study). The questionnaire ascertained a history of cholecystectomy and gallstone disease in first-degree relatives, as well as medical history, demographic, and anthropometric data. A logistic regression model was used to identify risk factors for symptomatic gallstone disease in a multivariate analysis. A maximum likelihood based variance decomposition approach was then used in 1,038 individuals from 358 families (family study) to estimate the additive genetic heritability of symptomatic gallstone disease. RESULTS In the association study significant risk factors for symptomatic gallstone disease were female gender (relative risk 8.8, P <.003), obesity (BMI > 30, relative risk 3.7, P <.001), age > 50 (relative risk 2.5, P <.001), and a positive family history of previous cholecystectomy in a first-degree family member (relative risk 2.2, P <.01). In the family study the additive genetic heritability of symptomatic gallstones was 29% (P <.02), age and gender were significant covariates and explained 9.3% of the phenotypic variation in gallbladder disease. CONCLUSIONS These data suggest that genetic factors are responsible for at least 30% of symptomatic gallstone disease. However, the true role of heredity in gallstone pathogenesis is probably higher because data based on symptomatic gallbladder disease underestimates the true prevalence in the population.
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Affiliation(s)
- Attila Nakeeb
- Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
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Reshetnikov OV, Ryabikov AN, Shakhmatov SG, Malyutina SK. Gallstone disease prevalence in Western Siberia: cross-sectional ultrasound study versus autopsy. J Gastroenterol Hepatol 2002; 17:702-7. [PMID: 12100617 DOI: 10.1046/j.1440-1746.2002.02758.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aims of this study were: (i) to evaluate the prevalence of gallstones in a Western Siberian urban population; and (ii) to compare the results of ultrasonographic screening of the living population with hospital autopsy data. METHODS A representative sample of 842 men and 870 women (aged 25-64 years) living in Novosibirsk, Western Siberia, was screened for the presence of gallstones by gallbladder ultrasonography. Participants were considered to have gallstone disease if they had already had cholecystectomy or if gallstones were revealed during the survey. Hospital autopsy data (n = 1124) were reviewed retrospectively for the 8-year period in the same region. RESULTS The prevalence of gallstone disease was significantly higher in women than in men and increased with age. Age-adjusted prevalence rates of gallstone disease for the 25-64-year age group were 1.9% in men and 9.5% in women in a cross-sectional ultrasonographic study. Corresponding values in the autopsy series were 2.2% in men and 11.2% in women. CONCLUSIONS The present report shows that the prevalence of gallstone disease in the female population is in the range of that reported from Western countries, whereas that in the male population is lower than that in other countries. The results of the ultrasonographic survey of the living population and of hospital autopsy data were comparable, with slightly higher gallstone detection rates in the autopsy study.
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Affiliation(s)
- Oleg V Reshetnikov
- Institute of Internal Medicine, Vladimirovsky spusk 2A, Novosibirsk 630003, Russia.
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Tseng M, Williams RC, Maurer KR, Schanfield MS, Knowler WC, Everhart JE. Genetic admixture and gallbladder disease in Mexican Americans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1998; 106:361-71. [PMID: 9696151 DOI: 10.1002/(sici)1096-8644(199807)106:3<361::aid-ajpa8>3.0.co;2-p] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Gallbladder disease is a common source of morbidity in the Mexican American population. Genetic heritage has been proposed as a possible contributor, but evidence for this is limited. Because gallbladder disease has been associated with Native American heritage, genetic admixture may serve as a useful proxy for genetic susceptibility to the disease in epidemiologic studies. The objective of our study was to examine the possibility that gallbladder disease is associated with greater Native American admixture in Mexican Americans. This study used data from the Hispanic Health and Nutrition Examination Survey and was based on 1,145 Mexican Americans who underwent gallbladder ultrasonography and provided usable phenotypic information. We used the GM and KM immunoglobulin antigen system to generate estimates of admixture proportions and compared these for individuals with and without gallbladder disease. Overall, the proportionate genetic contributions from European, Native American, and African ancestries in our sample were 0.575, 0.390, and 0.035, respectively. Admixture proportions did not differ between cases and noncases: Estimates of Native American admixture for the two groups were 0.359 and 0.396, respectively, but confidence intervals for estimates overlapped. This study found no evidence for the hypothesis that greater Native American admixture proportion is associated with higher prevalence of gallbladder disease in Mexican Americans. Reasons for the finding that Native American admixture proportions did not differ between cases and noncases are discussed. Improving our understanding of the measurement, use, and limitations of genetic admixture may increase its usefulness as an epidemiologic tool as well as its potential for contributing to our understanding of disease distributions across populations.
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Affiliation(s)
- M Tseng
- Department of Epidemiology and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, 27599, USA.
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Rosenstock SJ, Andersen LP, Rosenstock CV, Bonnevie O, Jørgensen T. Socioeconomic factors in Helicobacter pylori infection among Danish adults. Am J Public Health 1996; 86:1539-44. [PMID: 8916517 PMCID: PMC1380686 DOI: 10.2105/ajph.86.11.1539] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. METHODS Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. RESULTS Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). CONCLUSIONS Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals.
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Affiliation(s)
- S J Rosenstock
- Glostrup Population Studies, Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Denmark
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18
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Abstract
Many cases of gallstones can be explained in terms of the established risk factors, especially obesity. However, gallstones develop in some women who are not obese, and the causes are unknown. Biochemical studies have shown that slow intestinal transit is associated with lithogenic bile. We have tested the hypothesis that intestinal transit is abnormally slow in normal-weight women with gallstones. In a population survey, 1058 women aged 25-69 years, registered with general practitioners in Bristol, UK, underwent cholecystosonography. Gallstones were identified in 48 women, of whom 15 were of normal weight (body mass index < or = 25 kg/m2). These women and age-matched controls with healthy gallbladders then underwent measurement of whole-gut transit time (WGTT); the measurement was done directly when possible, or calculated from records of three defaecations. The mean WGTT was significantly longer in the women with gallstones than in the controls (82 vs 63 h; mean difference 19, 95% CI 2-37 h). Stool output was also lower in the women with gallstones (74 [SD 54] vs 141 [56] g per 24 h, p = 0.015). There was no significant difference between cases and controls in body mass index, waist-hip circumference ratio, parity, plasma triglyceride concentration, or alcohol intake. Normal-weight women with gallstones tend to have slow intestinal transit and this feature could explain why they have gallstones.
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Affiliation(s)
- K W Heaton
- University Department of Medicine, Bristol Royal Infirmary, UK
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Jørgensen T, Rafaelsen S. Gallstones and colorectal cancer--there is a relationship, but it is hardly due to cholecystectomy. Dis Colon Rectum 1992; 35:24-8. [PMID: 1733681 DOI: 10.1007/bf02053334] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of gallstone disease in 145 consecutive patients with colorectal cancer was compared with gallstone prevalence in 4,159 subjects randomly selected from a population. The group of patients had a significantly higher prevalence of gallstone disease than the population (odds ratio = 1.59; 95 percent confidence limits 1.04-2.45), whereas cholecystectomies occurred with equal frequency in the two groups. There was a nonsignificant trend toward more right-sided cancers in patients with gallstones than in patients without. These results, together with available literature, give substantial evidence for an association between gallstones and colorectal cancer, an association which is not due to cholecystectomy being a predisposing factor to colorectal cancer. Sporadic findings of an association between cholecystectomy and colorectal cancer can be explained by the above relationship.
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Affiliation(s)
- T Jørgensen
- Glostrup Population Studies, Medical Department C, Glostrup Hospital, University of Copenhagen, Denmark
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20
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Wille-Jørgensen P, Jørgensen T, Andersen M, Kirchhoff M. Postphlebitic syndrome and general surgery: an epidemiologic investigation. Angiology 1991; 42:397-403. [PMID: 2035891 DOI: 10.1177/000331979104200507] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Of a random sample comprising 4581 subjects from The Copenhagen County, 3608 (79%) attended an interview and a general health examination. The subjects were defined as suffering from subjective postphlebitic syndrome if they claimed of lower extremity pain or cramps at rest and from objective postphlebitic syndrome if varicose veins, edema, lower extremity ulcers, or skin changes were present. By means of logistic regression analysis, subjective postphlebitic syndrome was found independently associated with previous thromboembolism, obesity, increasing age, female sex, hormonal therapy, varicose veins, and previous major abdominal surgery. Objective postphlebitic syndrome was associated with previous thromboembolism, obesity, former birthgiving, and high social status. The findings support the view that subclinical deep venous thrombosis in connection with previous surgery may give rise to symptoms in the lower extremities.
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Affiliation(s)
- P Wille-Jørgensen
- Department of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark
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21
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Jørgensen T, Kay L, Schultz-Larsen K. The epidemiology of gallstones in a 70-year-old Danish population. Scand J Gastroenterol 1990; 25:335-40. [PMID: 2336544 DOI: 10.3109/00365529009095495] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A random sample of 540 men and women aged 70 years who lived in the western part of Copenhagen County was drawn from the National Central Person Register. The response rate was 74.8% among men and 63.7% among women. Each subject had the gallbladder examined by ultrasonography. The prevalence of gallstone disease was 30.2% and 18.8% among women and men, respectively, being significantly higher among women. Prevalence was assessed in relation to different social and clinical variables. In the univariate analyses gallstone disease was significantly associated with familial occurrence of gallstone disease and high body mass index, whereas it was not significantly associated with social status, childbirths, age at menopause, usage of menopausal hormone therapy, abstinence from alcohol, history of smoking, slimming treatments, and physical activity. By means of a multivariate analysis the history of smoking was found to be significantly associated with gallstone disease when body mass index was taken into account. The significant sex difference disappeared when childbirths and age at menopause were included, which means that clinical variables specific for women in the fertile period could explain the sex difference in gallstone prevalence.
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Affiliation(s)
- T Jørgensen
- Glostrup Population Studies, Dept. of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark
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22
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Abstract
A cross-sectional study of gallstone disease, ascertained by ultrasonography, comprised 4581 men and women of Danish origin, aged 30, 40, 50, and 60 years, of whom 3608 (79%) attended the investigation. The prevalence was assessed in relation to plasma concentrations of total cholesterol, high-density-lipoprotein cholesterol, low-density-lipoprotein cholesterol, and triglyceride. In the univariate analysis gallstone disease was significantly associated with high triglyceride and low high-density-lipoprotein cholesterol. No significant association among gallstones and total cholesterol and low-density-lipoprotein cholesterol was seen. In multivariate analyses triglyceride lost its significant association with gallstone disease, whereas total cholesterol became negatively associated with gallstones. This was seen for both the high-density-lipoprotein and the low-density-lipoprotein fraction of cholesterol. The difficulties in analysing present plasma lipid status with gallstone prevalence must be stressed. Looking only at small gallstones, which could represent newly formed stones, a change from a negative to a positive association between gallstone and both low-density-lipoprotein cholesterol and total cholesterol was seen.
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Affiliation(s)
- T Jørgensen
- Dept. of Surgical Gastroenterology, University of Copenhagen, Denmark
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Abstract
A cross-sectional study of gallstone disease, ascertained by ultrasonography, comprised 4581 men and women of Danish origin, aged 30, 40, 50, and 60 years, of whom 3608 (79%) took part in the investigation. The prevalence was assessed in relation to alcohol intake and number of daily meals. A randomly chosen subgroup of 593 persons was interviewed about their dietary habits. Both in the univariate and the multivariate analysis, gallstone disease was significantly related to abstinence from alcohol but not to number of meals. There was a trend towards positive association between gallstones and intake of refined sugars and total fat, whereas a negative trend was found between gallstones and intake of fibres and polyunsaturated to saturated fat ratio. None of the associations were significant. The same relations were observed when gallstones less than 10 mm were used in the analysis. The problem of assessing diet in relation to gallstone prevalence is stressed.
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Affiliation(s)
- T Jørgensen
- Dept. of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Denmark
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Jørgensen T. Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut 1989; 30:528-34. [PMID: 2785475 PMCID: PMC1434027 DOI: 10.1136/gut.30.4.528] [Citation(s) in RCA: 135] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The presence of gall stones diagnosed by ultrasonography in a cross sectional study was analysed in relation to relative weight, weight change since age 25, slimming treatment, physical activity, smoking, consumption of coffee, and diabetes mellitus. The random sample comprised 4581 men and women of Danish origin, aged 30, 40, 50, and 60 years, of whom 3608 (79%) attended the investigation. In women high body mass index, history of slimming treatment, and weight gain since the age of 25 of more than 5 body mass index units were each significantly associated with gall stones (p less than 0.05), while only body mass index was significant (p less than 0.05) in a multivariate analysis. In men history of slimming treatment was significantly associated (p less than 0.05) with gall stones in univariate and in multivariate analyses, where smoking also became significantly associated (p less than 0.05). No significant association was detected between gall stones and the other variables.
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Affiliation(s)
- T Jørgensen
- Department of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Denmark
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