The prevalence of cholesterol GSs has substantially increased in the last century, especially in affluent countries. Genetic and environmentalfactors have been implicated in the pathogenesis of GSs. Yet, the role of many specific environmental factors remains unclear.
Aim
To study the role of diet and lifestyle habits in the etiology of asymptomatic GS disease.
Methods
Subjects with asymptomatic, GB stones detected by abdominal US, after a fast of = 8 hours, were enrolled. A total of 103 newly diagnosedGS patients (75 females, 28 males) were matched by age, gender and ethnic origin to 103 GS -free subjects. All subjects underwentabdominal US and were extensively interviewed on their dietary habits using a FFQ, and on their lifestyle habits. Major food items wereanalyzed for their PL content and included in the food composition tables.
Results
The paired analysis revealed the following dietary risk factors for the development of GS:
High BMI (p<0.001), total fat intake (p=0.038), especially fat of animal origin (p=0.001), total protein (p<0.001), protein of animal origin(p<0.001), PS (p=0.016), chicken (p<0.001), high BMI at age 18 in females (p=0.007), in younger subjects (p= 0.029) and in Israel-born(p=0.006), high energy intake in females (p=0.023), beef in young subjects (p=0.029), fish in older subjects (p=0.002), and olives inIsrael-born (p=0.031).
The following factors were found to be negatively associated:
Dietary fiber (p=0.009), alcohol (p=0.039), starch in older subjects (p=0.030), zinc in Israel-born (p=0.028), dried fruit in young subjects(p=0.022), and soft drinks in Israel-born subjects (p=0.016).
In addition, being married (p=0.002), family history of GS (p<0.001), high serum cholesterol (p< 0.05) and high serum TGs (p< 0.05) werefound to correlate with the presence of GSs.
Conclusions
As indicated earlier there are a number of previous studies that dealt with the etiology of GSs, though the results are conflicting. One factorthat might have led to the variability of study results is the problem of study design as discussed in chapter 1. This study,however, had manystrengths due to its carefully planned study design, e.g. determination of GB status in all studied subjects by US examination, inclusion ofrecently diagnosed asymptomatic patients only, interview not longer than three months after first diagnosis and the use of a comprehensive,validated FFQ. Nevertheless, there is always a chance of recall bias and observer bias in those kind of studies and this has to beaccounted for.
Concluding, the results of the study suggest that nutritional factors are strongly associated with GS disease, as risk factors as well asprotective factors. The strong association with fat and protein of animal origin, suggests that foods of this origin increase the risk of GSdevelopment. The risk and protective factors which have been identified in this study are very similar to those found in a group of diseaseswhich have been characterized as typical Western diseases
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