Risk factors for gallbladder disease

摘要

Objective. Gallbladder disease (GBD) is a common condition and a cause of considerable morbidity and health care expense, but its risk factors are incompletely understood. This series of papers examined potential risk factors including: (1) diabetes mellitus and serum insulin and C-peptide concentrations, (2) coffee consumption, (3) serum ascorbic acid concentration, (4) central obesity, and (5) serum leptin concentration in a population-based study. Methods. A total of 13,962 adult participants in the Third National Health and Nutrition Examination Survey, 1988--1994, underwent gallbladder ultrasonography and a subgroup of 6,153 underwent phlebotomy after an overnight fast. Serum leptin concentration was measured. GBD was defined as ultrasound-documented gallstones or evidence of a cholecystectomy. Results. After controlling for known GBD risk factors, among women undiagnosed diabetes was associated with increased GBD occurrence (prevalence ratio (PR) = 1.9, 95% confidence interval (C.I.) = 1.3--2.8). GBD prevalence in women increased with fasting insulin concentration (PR = 1.6, 95% C.I. = 1.1--2.4) comparing highest to lowest quintiles. However, the association of GBD with undiagnosed diabetes was not diminished when the model included insulin. Total GBD prevalence was unrelated to coffee consumption. However, among women a decreased occurrence of previously diagnosed GBD was found with increasing coffee drinking (p = 0.027). GBD prevalence decreased with increasing serum ascorbic acid concentration among women. Women with a serum ascorbic acid concentration in the highest quintile had an almost 30 percent lower prevalence of GBD than those in the lowest quintile (PR = 0.7, 95% C.I. = 0.6--0.9). Central adiposity was associated with increased GBD prevalence, but only in men in the highest waist-to-thigh circumference ratio quintile (PR = 1.7, 95% C.I. = 1.2--2.4). No statistically significant association was demonstrated between serum leptin concentration and GBD after controlling for BMI. Conclusions. Among women, higher fasting serum insulin concentration may increase GBD risk, but did not account for the increased occurrence in persons with diabetes. Coffee consumption was unrelated to total GBD, but may decrease the risk of symptomatic gallstones in women. A higher serum ascorbic acid concentration may be protective against GBD in women. Central adiposity was associated with increased GBD prevalence in men with the highest waist-to-thigh circumference ratios. Serum leptin concentration was not a better predictor of GBD than BMI.