Skip to main content Accesibility Help
×
×
Home

Dietary intake and gallbladder disease: a review

  • Marilyn Tseng (a1), James E Everhart (a2) and Robert S Sandler (a3)
Abstract
Objective

Dietary intake has long been looked upon as a potentially modifiable risk factor for gallbladder disease (GBD), here defined as either having gallstones or having had surgery for gallstones. This paper reviews the epidemiological evidence for an association between dietary intake and GBD, focusing on six dietary factors that have received the most attention in studies in this area: energy intake, fatty acids, cholesterol, carbohydrates and fibre, calcium and alcohol. The objectives of this review are to evaluate the potential usefulness of altering the diet to prevent GBD and to consider future research in this area.

Design

We reviewed all English-language epidemiological studies on diet and cholelithiasis that were cross-sectional, cohort or case–control in design and that were indexed in the Medline database from 1966 to October 1997.

Results

A positive association was suggested with simple sugars and inverse associations with dietary fibre and alcohol. No convincing evidence was found for a role for energy intake or intake of fat or cholesterol. Variable means of ascertaining cases and inaccurate measurement of dietary intake may contribute to variation in results across studies.

Conclusions

Some specific components of the diet that may affect GBD include simple sugars, fibre and alcohol, but whether risk for GBD can be reduced by altering intake of a specific dietary factor has not been established. Although no specific dietary recommendations can be made to reduce risk of GBD per se, a ‘healthy’ diet aimed at reducing risk of other diseases might be expected to reduce risk for GBD as well.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dietary intake and gallbladder disease: a review
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dietary intake and gallbladder disease: a review
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dietary intake and gallbladder disease: a review
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Email m_tseng@fccc.edu
References
Hide All
1Everhart, JE. Gallstones. In: Everhart, J, ed. Digestive Diseases in the United States: Epidemiology and Impact. NIH Publication No. 94–1447. Washington, DC: US Government Printing Office, 1994: 647–90.
2Diehl, AK. Epidemiology and natural history of gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 119.
3Sama, C, Labate, AMM, Taroni, F, Barbara, L. Epidemiology and natural history of gallstone disease. Semin. Liver Dis. 1990; 10: 149–58.
4Everhart, JE. Contributions of obesity and weight loss to gallstone disease. Ann. Intern. Med. 1993; 119: 1029–35.
5Messing, B, Bories, C, Kunstlinger, F, Bernier, JJ. Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology 1983; 84: 1012–19.
6Roslyn, JJ, Pitt, HA, Mann, LL, Ament, ME, DenBesten, L. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 1983; 84: 148–54.
7Holzbach, RT. Gallbladder stasis: consequence of long-term parenteral hyperalimentation and risk factor for cholelithiasis. Gastroenterology 1983; 84: 1055–8.
8Hayes, KC, Livingston, A, Trautwein, EA. Dietary impact on biliary lipids and gallstones. Annu. Rev. Nutr. 1992; 12: 299326.
9Cooper, AD. Epidemiology, pathogenesis, natural history, and medical therapy of gallstones. In: Sleisenger, MH, ed. Gastrointestinal Diseases: Pathophysiology, Diagnosis, Management. Philadelphia: WB Saunders Company, 1993.
10Cooper, AD. Metabolic basis of cholesterol gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 2146.
11Carey, MC. Pathogenesis of gallstones. Am. J. Surgery 1993; 165: 410–19.
12Everson, GT. Gallbladder function in gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 85110.
13Donovan, JM, Carey, MC. Physical-chemical basis of gallstone formation. Gastroenterol. Clin. North Am. 1991; 20: 4766.
14Holzbach, RT, Busch, N. Nucleation and growth of cholesterol crystals: kinetic determinants in supersaturated native bile. Gastroenterol. Clin. North Am. 1991; 20: 6784.
15Heaton, KW, Braddon, REM, Mountford, RA, Emmitt, PM. Symptomatic and silent gall stones in the community. Gut 1991; 32: 316–20.
16Zeman, RK. Noninvasive imaging of the biliary tract. In: Haubrich, WS, Schaffner, F, Berk, JE, eds. Bockus Gastroenterology, Vol. 3. Philadelphia: WB Saunders Company, 1995: 2573–96.
17Diehl, AK, Schwesinger, WH, Holleman, DR JrChapman, JB, Kurtin, WE. Clinical correlates of gallstone composition: distinguishing pigment from cholesterol stones. Am. J. Gastroenterol. 1995; 90: 967–72.
18Mok, HY, Druffel, ER, Rampone, WM. Chronology of cholelithiasis. Dating gallstones from atmospheric radiocarbon produced by nuclear bomb explosions. N. Engl. J. Med. 1986; 314: 1075–7.
19Thijs, C, Knipschild, P, Leffers, P. Does alcohol protect against the formation of gallstones? A demonstration of protopathic bias. J. Clin. Epidemiol. 1991; 44: 941–6.
20Van der Linden, W, Bergman, F. Formation and dissolution of gallstones in experimental animals. Int. Rev. Exp. Pathol. 1977; 17: 173233.
21Maurer, KR, Everhart, JE, Knowler, WC, Shawker, TH, Roth, HP. Risk factors for gallstone disease in the Hispanic populations of the United States. Am. J. Epidemiol. 1990; 131: 836–44.
22Hanis, CL, Hewett-Emmett, D, Kubrusly, LF, et al. An ultrasound survey of gallbladder disease among Mexican Americans in Starr County, Texas: frequencies and risk factors. Ethnicity Dis. 1993; 3: 3243.
23Williams, CN, Johnston, JL, Weldon, KLM. Prevalence of gallstones and gallbladder disease in Canadian Micmac Indian women. Can. Med. Assoc. J. 1977; 117: 758–60.
24Williams, CN, Johnston, JL. Prevalence of gallstones and risk factors in Caucasian women in a rural Canadian community. Can. Med. Assoc. J. 1980; 122: 664–8.
25Jørgensen, T, Kay, L, Schultz-Larsen, K. The epidemiology of gallstones in a 70-year-old Danish population. Scand. J. Gastroenterol. 1990; 25: 335–40.
26Rhomberg, HP, Judmair, G, Lochs, A. How common are gall stones? BMJ 1984; 289: 1002.
27Pixley, F, Wilson, D, McPherson, K, Mann, J. Effect of vegetarianism on development of gall stones in women. BMJ 1985; 291: 1112.
28Kono, S, Kochi, S, Ohyama, S, Wakisaka, A. Gallstones, serum lipids, and glucose tolerance among male officials of self-defense forces in Japan. Dig. Dis. Sci. 1988; 33: 839–44.
29Kono, S, Shinchi, K, Ikeda, N, Yanai, F, Imanishi, K. Prevalence of gallstone disease in relation to smoking, alcohol use, obesity, and glucose tolerance: a study of self-defense officials in Japan. Am. J. Epidemiol. 1992; 136: 787–94.
30Kono, S, Shinchi, K, Todoroki, I et al. Gallstone disease among Japanese men in relation to obesity, glucose intolerance, exercise, alcohol use, and smoking. Scand. J. Gastroenterol. 1995; 30: 372–6.
31Jørgensen, T. Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut 1989; 30: 528–34.
32Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. II. Factors associated with the disease. Hepatology 1988; 8: 907–13.
33Khuroo, MS, Mahajan, R, Zargar, SA, Javid, G, Sapru, S. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989; 30: 201–5.
34Barbara, L, Sama, C, Labate, AMM, et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913–17.
35Barbara, L, Festi, D, Frabboni, R et al. Incidence and risk factors for gallstone disease: the ‘Sirmione study’. Hepatology 1988; 8: 1256.
36Khare, M, Everhart, JE, Maurer, KR, Hill, MC. Association of ethnicity and body mass index (BMI) with gallstone disease in the United States. Am. J. Epidemiol. 1996; 141 (Suppl.): S69.
37Friedman, GD, Kannel, WB, Dawber, TR. The epidemiology of gallbladder disease: observations in the Framingham study. J. Chron. Dis. 1966; 19: 273–92.
38Layde, PM, Vessey, MP, Yeates, D. Risk factors for gall-bladder disease: a cohort study of young women attending family planning clinics. J. Epidemiol. Community Health 1982; 36: 274–8.
39Maclure, KM, Hayes, KC, Colditz, GA, Stampfer, MJ, Speizer, FE, Willett, WC. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N. Engl. J. Med. 1989; 321: 563–9.
40Stampfer, MJ, Maclure, KM, Colditz, GA, Mansun, JAE, Willett, WC. Risk of symptomatic gallstones in women with severe obesity. Am. J. Clin. Nutr. 1992; 55: 652–8.
41Grodstein, F, Colditz, GA, Hunter, DJ, Mansun, JE, Willett, WC, Stampfer, MJ. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstet. Gynecol. 1994; 84: 207–14.
42Kato, I, Nomura, A, Stemmermann, GN, Chyou, PH. Prospective study of clinical gallbladder disease and its association with obesity, physical activity, and other factors. Dig. Dis. Sci. 1992; 37: 784–90.
43La Vecchia, C, Negri, E, D'Avanzo, B, Franceschi, S, Boyle, P. Risk factors for gallstone disease requiring surgery. Int. J. Epidemiol. 1991; 20: 209–15.
44Scragg, KR, McMichael, AJ, Baghurst, PA. Diet, alcohol, and relative weight in gall stone disease: a case-control study. BMJ 1984; 288: 1113–19.
45Basso, L, McCollum, PT, Darling, MR, Tocchi, A, Tanner, WA. A descriptive study of pregnant women with gallstones. Relation to dietary and social habits, education, physical activity, height, and weight. Eur. J. Epidemiol. 1992; 8: 629–33.
46Maringhini, A, Marceno, MP, Lanzarone, F et al. Sludge and stones in gallbladder after pregnancy. Prevalence and risk factors. J. Hepatol. 1987; 5: 218–23.
47Heaton, KW. The role of diet in the aetiology of cholelithiasis. In: Capocaccia, L, Ricci, G, Angelico, F, Angelico, M, Attili, AF, eds. Epidemiology and Prevention of Gallstone Disease. Lancaster: MTP Press, 1984.
48Burkitt, DP, Tunstall, M. Gallstones: geographical and chronological features. J. Trop. Med. Hyg. 1975; 78: 140–4.
49Brett, M, Barker, DJP. The world distribution of gallstones. Int. J. Epidemiol. 1976; 5: 335–41.
50Malhotra, SL. Epidemiological study of cholelithiasis among railroad workers in India with special to causation. Gut 1968; 9: 290–5.
51Sarles, H, Gerolami, A, Bord, A. Diet and cholesterol gallstones: a further study. Digestion 1978; 17: 128–34.
52Nakayama, F, Miyake, H. Changing state of gallstone disease in Japan. Am. J. Surg. 1970; 120: 794–9.
53Sarles, H, Chabert, C, Pommeau, Y, Save, E, Mouret, H, Gerolami, A. Diet and cholesterol gallstones: a study of 101 patients with cholelithiasis compared to 101 matched controls. Am. J. Dig. Dis. 1969; 14: 531–7.
54Tandon, RK, Saraya, A, Paul, S, Kapur, BML. Dietary habits of gallstone patients in northern India. J. Clin. Gastroenterol. 1996; 22: 23–7.
55Ortega, RM, Fernández-Azuela, M, Encinas-Sotillos, A, Andrés, P, López-Sobaler, AM. Differences in diet and food habits between patients with gallstones and controls. J. Am. Coll. Nutr. 1997; 16: 8895.
56Wheeler, M, Hills, LL, Laby, B. Cholelithiasis: a clinical and dietary survey. Gut 1970; 11: 430–7.
57Smith, DA, Gee, MI. A dietary survey to determine the relationship between diet and cholelithiasis. Am. J. Clin. Nutr. 1979; 32: 1519–26.
58Pixley, F, Mann, J. Dietary factors in the aetiology of gall stones: a case-control study. Gut 1988; 29: 1511–15.
59Worthington, HV, Hunt, LP, McCloy, RF, Maclennan, I, Braganza, JM. A pilot study of antioxidant intake in patients with cholesterol gallstones. Nutrition 1997; 13: 118–27.
60Sarin, SK, Negi, VS, Dewan, R, Sasan, S, Saraya, A. High familial prevalence of gallstones in the first-degree relatives of gallstone patients. Hepatology 1995; 22: 138–41.
61Sichieri, R, Everhart, JE, Roth, H. A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting. Am. J. Public Health 1991; 81: 880–4.
62Low-Beer, TS. Nutrition and cholesterol gallstones. Proc. Nutr. Soc. 1985; 44: 127–34.
63Reid, SM, Fullmer, SD, Pettigrew, KD et al. Nutrient intake of Pima Indian women: relationships to diabetes mellitus and gallbladder disease. Am. J. Clin. Nutr. 1971; 24: 1281–9.
64Wysowski, DK, Goldberg, EL, Comstock, GW, Diamond, EL. A study of a possible association between breast cancer and gallbladder disease. Am. J. Epidemiol. 1986; 123: 532–43.
65Jørgensen, T, Jørgensen, LM. Gallstones and diet in a Danish population. Scand. J. Gastroenterol. 1989; 24: 821–6.
66Diehl, AK, Haffner, SM, Knapp, JA, Hazuda, HP, Stern, MP. Dietary intake and the prevalence of gallbladder disease in Mexican Americans. Gastroenterology 1989; 97: 1527–33.
67Moerman, CJ, Smeets, FWM, Kromhout, D. Dietary risk factors for clinically diagnosed gallstones in middle-aged men. Ann. Epidemiol. 1994; 4: 248–54.
68Sturdevant, R, Pearce, M, Dayton, S. Increased prevalence of cholelithiasis in men ingesting a serum-cholesterol-lowering diet. N. Engl. J. Med. 1973; 288: 24–7.
69Miettinen, M, Turpeinen, O, Karvonen, M, Paavilainen, E, Elosuo, R. Prevalence of cholelithiasis in men and women ingesting a serum-cholesterol-lowering diet. Ann. Clin. Res. 1976; 8: 111–16.
70Kato, I, Kato, K, Akai, S, Tominaga, S. A case-control study of gallstones: a major risk factor for biliary tract cancer. Jpn J. Cancer Res. 1990; 81: 578–83.
71Maclure, KM, Hayes, KC, Colditz, GA, Stampfer, MJ, Willett, WC. Dietary predictors of symptom-associated gallstones in middle-aged women. Am. J. Clin. Nutr. 1990; 52: 916–22.
72Misciagna, G, Leoci, C, Guerra, V et al. Epidemiology of cholelithiasis in southern Italy. Eur. J. Gastroenterol. Hepatol. 1996; 8: 585–93.
73Pastides, H, Tzonou, A, Trichopoulos, D et al. A case-control study of the relationship between smoking, diet, and gallbladder disease. Arch. Intern. Med. 1990; 150: 1409–12.
74Berr, F, Holl, J, Jungst, D et al. Dietary n-3 polyunsaturated fatty acids decrease biliary cholesterol saturation in gallstone disease. Hepatology 1992; 16: 960–7.
75Nestel, PJ. Effects of n-3 fatty acids on lipid metabolism. Annu. Rev. Nutr. 1990; 10: 149–67.
76Attili, AF. Dietary habits and cholelithiasis. In: Capocaccia, L, Ricci, G, Angelico, F, Angelico, M, Attili, AF, eds. Epidemiology and Prevention of Gallstone Disease. Lancaster, UK: MTP Press, 1984: 175–81.
77DenBesten, L, Connor, WE, Bell, S. The effect of dietary cholesterol on the composition of human bile. Surgery 1973; 73: 266–73.
78Lee, DWT, Gilmore, CJ, Bonorris, G et al. Effect of dietary cholesterol on biliary lipids in patients with gallstones and normal subjects. Am. J. Clin. Nutr. 1985; 42: 414–20.
79Kern, F Jr. Effects of dietary cholesterol on cholesterol and bile acid homeostasis in patients with cholesterol gallstones. J. Clin. Invest. 1994; 93: 1186–94.
80Dam, H, Prange, I, Jensen, MK, Kallehauge, HE, Fenger, HJ. Studies on human bile. IV. Influence of ingestion of cholesterol in the form of eggs on the composition of bile in healthy subjects. Z. Ernahrungswiss. 1971; 10: 178–87.
81Andersen, E, Hellstrom, K. The effect of cholesterol feeding on bile acid kinetics and biliary lipids in normolipidemic and hypertriglyceridemic subjects. J. Lipid Res. 1979; 20: 1020–7.
82Everson, GT, McKinley, C, Kern, F Jr. Mechanisms of gallstone formation in women: effects of exogenous estrogen (Premarin®) and dietary cholesterol on hepatic lipid metabolism. J. Clin. Invest. 1991; 87: 237–46.
83Ahmed, AF, Osman, AK, Bustami, AB, Aldirwish, S, Bashir, S. A pilot study of diet and gallstone formation in young Saudi women. J. R. Soc. Health 1993; 113: 57–9.
84Marcus, SN, Wheaton, KW. Intestinal transit rate, deoxycholic acid and the cholesterol saturation of bile — three interrelated factors. Gut 1986; 27: 550–8.
85Marcus, SN, Wheaton, KW. Effects of a new, concentrated wheat fiber preparation on intestinal transit, deoxycholic acid metabolism and the composition of bile. Gut 1986; 27: 893900.
86Alessandrini, A, Busco, MA, Gatti, E, Rossi, PA. Dietary fibres and cholesterol gallstones: a case control study. Ital. J. Gastroenterol. 1982; 14: 156–8.
87Hood, KA, Gleeson, D, Ruppin, DC, Dowling, RH. Gall stone recurrence and its prevention: the British/Belgian Gall Stone Study Group's post-dissolution trial. Gut 1993; 9: 1277–88.
88Linos, AD, Daras, V, Linos, DA, Kekis, V, Tsoukas, MM, Golematis, V. Dietary and other risk factors in the aetiology of cholelithiasis: a case control study. HPB Surg. 1989; 1: 221–7.
89Thornton, J, Symes, C, Heaton, K. Moderate alcohol intake reduces bile cholesterol saturation and raises HDL cholesterol. Lancet 1983; 2: 819–22.
90La Vecchia, C, Decarli, A, Ferraroni, M, Negri, E. Alcohol drinking and prevalence of self-reported gallstone disease in the 1983 Italian National Health Survey. Epidemiology 1994; 5: 533–6.
91Fornari, F, Civardi, G, Buscarini, E et al. Cirrhosis of the liver. A risk factor for development of cholelithiasis in males. Dig. Dis. Sci. 1990; 35: 1403–8.
92Acalovschi, M, Badea, R, Dumitrascu, D, Varga, C. Prevalence of gallstones in liver cirrhosis: a sonographic survey. Am. J. Gastroenterol. 1988; 83: 954–6.
93Kratzer, W, Kächele, V, Mason, RA et al. Gallstone prevalence in relation to smoking, alcohol, coffee consumption, and nutrition. Scand. J. Gastroenterol. 1997; 32: 953–8.
94Abdel-Rahman, HA, Hafez, AS, Maymoun, NM et al. Risk factors of gallstone disease in a sample of patients in Benha City. J. Egypt. Public Health Assoc. 1993; 68: 205–27.
95Leitzmann, MF, Giovannucci, E, Rimm, EB, Stampfer, MJ, Willett, WC. Physical activity and the risk of gallstone disease in men. Ann. Intern. Med. 1998; 128: 415–25.
96US Department of Agriculture/US Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC: US Government Printing Office, 1990.
97US Department of Agriculture/US Department of Health and Human Services. The Food Guide Pyramid. Washington, DC: US Government Printing Office, 1992.
98Sama, C, Morselli Labate, AMCornia, GL et al. Dietary habit and cholelithiasis: results of an epidemiological study. Hepatology 1985; 5: 984.
99Diehl, AK, Haffner, SM, Hazuda, HP, Stern, MP. Coronary risk factors and clinical gallbladder disease: an approach to the prevention of gallstones?. Am. J. Public Health 1987; 77: 841–5.
100Klatsky, AL, Friedman, GD, Siegelaub, AB. Alcohol use and cardiovascular disease: the Kaiser–Permanente experience. Circulation 1981; 64 (Suppl. III): 3241.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed