Background: The role of physical activity in preventing gallstone disease independent of its effect on the body weight has not been well established. We performed a systematic review and meta-analysis of cohort and case-control studies to analyze this potential association.
Methods: We searched PubMed and EMBASE to identify all published studies in English through April 2016. We pooled the relative risks (RRs) or odds ratios (ORs) and corresponding 95% confidence intervals (CIs) from individual studies using a random-effects model to investigate associations between physical activity and the risk of gallstone disease.
Results: A total of 16 studies comprising 19 independent reports of approximately 260,000 participants met the inclusion criteria, including 6 case-control studies and 13 cohort studies. In a pooled analysis of cohort studies, physical activity (in a comparison of the highest-level and the lowest-level groups) was associated with a reduced risk of gallstone disease (RR=0.85; 95% CI, 0.78-0.92; I2=79.5%). For men, the RR was 0.76 (95% CI, 0.60-0.97), and for women, the RR was similar (RR=0.77; 95% CI, 0.66-0.91). In a dose-response analysis, the RR of gallstone disease was 0.87 (95% CI, 0.83-0.92; I2=1.0%) per 20 metabolic equivalent-hours of recreational physical per week. In comparison, case-control studies yielded a stronger significant risk reduction for gallstone disease (OR=0.64; 95% CI, 0.46-0.90; I2=76.6%).
Conclusions: This study suggests an inverse association between physical activity and gallstone disease in both men and women; however, these findings should be interpreted cautiously because of study heterogeneity.
Department of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Zhengzhou, P.R. China
Supported by grants from the National Natural Science Foundation of China (No. 81301618) and the Science and Technology Bureau of Zhengzhou (No. 131PLJRC658).
Y.-P.Z. and Y.-L.S. conceived the study, participated in the design, collected the data, and drafted the manuscript. Y.-L.Z. and W.-J.W. collected the data, and performed statistical analyses. R.-T.Z. helped to collect the data. W.-J.W. conceived the study, participated in the design, and helped to draft the manuscript. Y.-L.Z. and J.L. edited and checked the manuscript. All of the authors have read and approved the final manuscript.
The authors declare that they have nothing to disclose.
Address correspondence to: Yu-Ling Sun, MD, Department of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, The First Affiliated Hospital of Zhengzhou University, School of Medicine, 1 Jianshe Road, Zhengzhou 450052, P.R. China (e-mail: firstname.lastname@example.org).
Received February 19, 2016
Accepted May 15, 2016