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The aetiology of symptomatic gallstones quantification of the effects of obesity, alcohol and serum lipids on risk. Epidemiological and biomarker data from a UK prospective cohort study (EPIC-Norfolk)

Banim, Paul J.R.a; Luben, Robert N.c; Bulluck, Heerajnarainb; Sharp, Stephen J.d; Wareham, Nicholas J.d; Khaw, Kay-Teec; Hart, Andrew R.a,b

European Journal of Gastroenterology & Hepatology: August 2011 - Volume 23 - Issue 8 - p 733–740
doi: 10.1097/MEG.0b013e3283477cc9
Original Articles: Gallstones

Objective The development of gallstones is influenced by obesity and alcohol. This study aimed to precisely quantify these risks and investigate whether the aetiological mechanism may involve serum lipids, for the first time using a European prospective cohort study.

Methods The European Prospective Investigation into Cancer-Norfolk, recruited 25 639 men and women, aged 40 to 74 years, between 1993 and 1997. At enrolment weight, height and alcohol intake were recorded and nonfasting blood samples taken to measure serum triglycerides, cholesterol, high-density lipoproteins and low-density lipoproteins. The cohort was monitored for 14 years for symptomatic gallstones. Cox regression estimated sex-specific hazard ratios (HRs) for symptomatic gallstones adjusted for covariates.

Results Symptomatic gallstones developed in 296 people (67.9% women). For each additional unit of BMI, the HR in men was 1.08 [95% confidence interval (CI)=1.02–1.14]; in women the HR was 1.08 (95% CI=1.06–1.11). Every unit of alcohol consumed per week decreased risk in men by 3% (HR=0.97, 95% CI=0.95–0.99) with no effect in women. Serum triglycerides increased risk in men (highest vs. lowest quarter HR=2.02, 95% CI=1.03–3.98) and women (HR=2.43, 95% CI=1.52–3.90). Increased high-density lipoprotein was associated with a decreased risk in men (highest vs. lowest quarter HR=0.22, 95% CI=0.09–0.52) and women (HR=0.55, 95% CI=0.36–0.85). No effects were found for serum cholesterol and low-density lipoprotein.

Conclusion Obesity and alcohol influence gallstone formation, possibly in part through their effects on serum lipids. Reducing obesity may prevent gallstones in the population, as 38% of incident cases of gallstones were associated with a BMI of more than 25.

aSchool of Medicine, Health Policy and Practice, University of East Anglia

bNorfolk and Norwich University Hospital NHS Trust, Norwich

cInstitute of Public Health, University of Cambridge

dMRC Epidemiology Unit, Cambridge, UK

Data presented previously in abstract form at the following meetings: British Society of Gastroenterology (BSG) Meeting 2009, Glasgow, UK: Plenary poster: alcohol intake and development of gallstones: an inverse association: An UK prospective cohort study. Banim PJR, Luben R, Bulluck H, Sharp SJ, Wareham NJ, Khaw K-T, Hart AR. Gut 2009; 58 (Suppl 1):A44.

Digestive Disease Week (DDW) 2009, Chicago, US; Oral presentation; Alcohol Intake and Development of Symptomatic Gallstones: an Inverse Association. An UK Prospective Cohort Study. Banim PR, Bulluck H, Sharp SJ, Khaw K-T, Wareham NJ, Hart AR. Gastroenterology 2009; 136 (Suppl 1):A-1Andrew HaNN

Digestive Disease Week (DDW) 2009, Chicago, US: Oral Presentation; Body Mass Index and the Risk of Symptomatic Gallstones: A Prospective Cohort Study in an UK Population. Bulluck H, Banim PJR, Sharp SJ, Khaw K-T, Wareham NJ, Hart AR. Gastroenterology 2009; 136 (Suppl 1):A-1Andrew HaNN

British Society of Gastroenterology Meeting 2010, Liverpool, UK. Oral presentation; Serum lipids and the risk of developing symptomatic gallstones: an UK prospective cohort study. Banim PJR, Luben R, Bulluck H, Wareham NJ, Khaw K-T, Hart AR. Gut 2010; 59 (Suppl 1):A44.

Digestive Disease Week (DDW) 2010, New Orleans, US: Poster of distinction; Serum Lipids and the Risk of Developing Symptomatic Gallstones: an UK Prospective Cohort Study Banim PR, Bulluck H, Sharp SJ, Khaw K-T, Wareham NJ, Hart AR. Gastroenterology 2010; 138 (Suppl 1):S-211.

Correspondence to Dr Paul J.R. Banim, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ Tel: +01603 597191; fax: +01603 593752; e-mail: p.banim@uea.ac.uk

Received January 21, 2011

Accepted April 5, 2011

© 2011 Lippincott Williams & Wilkins, Inc.