Obesity Classification And The Risk Of Gallstones
Overview
This population-based cross-sectional study aimed to determine the most effective predictor of gallstone disease (GSD) among various anthropometric indicators of obesity. The research, conducted in Taiwan from 2014 to 2017, included 2263 participants who underwent physical examinations, provided blood samples, and completed detailed questionnaires on demographics, medical history, and lifestyle.
The study revealed an overall GSD prevalence of 8.8%. Multivariate analyses identified a waist-to-height ratio ≥0.5 as a significant predictor for an increased risk of GSD (odds ratio (OR) = 1.65, 95% confidence interval (CI) = 1.10−2.48, p = 0.017). Notably, diabetes emerged as the primary risk factor for GSD in men (OR = 2.06, 95% CI = 1.17−3.65, p = 0.013).
In the case of women, a waist-to-height ratio >0.5 (OR = 1.76, 95% CI = 1.03−3.02, p = 0.040) and current use of hormone drugs (OR = 2.73, 95% CI = 1.09−6.84, p = 0.033) were identified as significant risk factors for gallstones.
Conclusively, GSD exhibited independent associations with central obesity and the use of exogenous hormones in women. Among the anthropometric indicators used to assess central obesity, the waist-to-height ratio demonstrated the highest accuracy as a predictor of GSD. This study provides valuable insights into the relationships between obesity indicators and GSD risk, emphasizing the significance of central obesity, especially as measured by the waist-to-height ratio, in predicting gallstone disease.
Introduction
Gallstone disease (GSD) is a prevalent digestive disorder with complex origins, often asymptomatic but necessitating surgical intervention in symptomatic cases, imposing a strain on healthcare resources. Key factors associated with GSD include age, sex, coffee and tea consumption, physical inactivity, and components of metabolic syndrome like central obesity, dyslipidemia, type 2 diabetes, and cirrhosis. Understanding these epidemiological patterns is vital for early detection and prevention of gallstones, particularly in patients showing symptoms of GSD-related complications.
In the context of Taiwan, where a substantial increase in metabolic syndrome and obesity has been noted, obesity stands out as a well-established risk factor for GSD. The association between obesity and GSD is linked to increased hepatic cholesterol secretion and compromised gallbladder motility. Clinical indicators of obesity, such as weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), are employed for assessment.
Despite the recognized importance of obesity in GSD, the comparative predictability of different anthropometric indicators, especially WHtR, remains unclear. This study aims to fill this gap by exploring the relationship between GSD and metabolic syndrome components, determining the most efficient predictor of gallstones among various adiposity indicators. Additionally, the research delves into the role of exogenous hormone use, parity, and cirrhosis in GSD development. The findings are anticipated to contribute valuable insights to clinical practices, enhancing diagnostic accuracy for GSD and facilitating patient education and preventive strategies.
Method
In this community-based cross-sectional study conducted in northeastern Taiwan, spanning from April 2014 to August 2017, researchers aimed to comprehensively explore the associations between gallstone disease (GSD) and various anthropometric and metabolic factors. The study was part of the Northeastern Taiwan Community Medicine Research Cohort, and it enrolled participants aged 30 years and older from both rural and urban districts in the region.
The research design incorporated a range of health examinations and data collection methods to obtain a thorough understanding of the factors influencing GSD. Participants’ socioeconomic status, educational level, lifestyle habits (including alcohol consumption, tea and coffee consumption, and smoking history), physical activity levels, family history, and personal medical histories were assessed through structured in-person interviews administered by trained healthcare professionals.
Anthropometric indicators such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were measured to evaluate obesity and central adiposity. These measurements were crucial in understanding the role of obesity in GSD, as previous studies have highlighted its association with gallstone formation.
Blood samples were collected after an overnight fast to analyze liver biochemistry, lipid profiles, glucose levels, and insulin resistance. The homeostatic model assessment of IR (HOMA-IR) was used to quantify insulin resistance, a key factor in metabolic syndrome.
Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT), providing insights into participants’ drinking habits. Abdominal ultrasonography examinations were conducted by an experienced gastroenterologist to diagnose GSD based on the presence of gallstones. Additionally, a fibrosis scoring system and the Fibrosis-4 (FIB-4) index were employed to evaluate the degree of hepatic fibrosis.
The study delved into the complexities of metabolic syndrome by employing specific criteria to define its presence. Metabolic syndrome is known to be associated with various components, including increased waist circumference, elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, high blood pressure, and elevated fasting glucose levels.
Statistical analyses, including logistic regression, were conducted to identify independent risk factors for GSD. Results indicated significant associations between GSD and central obesity, alcohol consumption, and insulin resistance. The findings contribute valuable insights into the intricate relationships between anthropometric and metabolic factors in the development of gallstone disease.
Importantly, the study adhered to ethical guidelines outlined in the Declaration of Helsinki and received approval from the Ethical Committee of the Keelung Chang Gung Memorial Hospital. The datasets generated during the study are available from the corresponding author upon reasonable request, ensuring transparency and the potential for further research based on the collected information.
Result
In this study encompassing 2263 participants (788 men and 1475 women) from northeastern Taiwan, the prevalence of gallstone disease (GSD) was found to be 8.8%. Notably, the prevalence was higher in men (10.4%) compared to women (7.9%). The incidence of GSD increased with age, with individuals over 60 years exhibiting the highest prevalence at 11.3%.
Analysis of participant characteristics revealed that those with GSD tended to have a higher prevalence of smoking, lower educational qualifications, and lower levels of physical exercise. Female participants with gallstones specifically exhibited a history of hormone drug use (4.1% vs. 1.6%) and multiparity (childbirth ≥3; 61.6% vs. 47.5%).
Clinical and laboratory assessments showed that individuals with GSD had significantly higher body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), fasting glucose, glycated hemoglobin (HbA1c), high-density lipoprotein (HDL) cholesterol levels, and FIB‐4 scores compared to those without GSD. Additionally, the prevalence of diabetes mellitus (DM) and metabolic syndrome was higher in participants with gallstones.
Univariate analysis revealed several factors significantly associated with GSD, including age, male sex, obesity (BMI >27 kg/m²), central obesity (increased WC or WHtR >0.5), elevated triglyceride levels, fasting glucose levels >5.55 mmol/L or the use of glucose-lowering drugs, low HDL levels or use of HDL cholesterol-raising drugs, platelet levels <15 × 10⁹/L, insulin resistance (HOMA-IR ≥2), HbA1c >5.7%, DM, FIB‐4 score >1.45, metabolic syndrome, smoking more than 20 packs per year, multiparity, and exogenous hormone drug use in female participants.
In the multivariate model, WHtR >0.5 emerged as the sole significant risk factor for GSD (OR = 1.65, 95% CI = 1.10–2.48, p = 0.017). Moreover, diabetes and tobacco smoking were marginally associated with GSD. Stratified by sex, diabetes was identified as the primary risk factor for GSD in men (OR = 2.06, 95% CI = 1.17–3.65, p = 0.013). Among women, WHtR >0.5 (OR = 1.76, 95% CI = 1.03–3.02, p = 0.040) and exogenous hormone intake (OR = 2.73, 95% CI = 1.09–6.84, p = 0.033) were significantly associated with GSD, while parity (childbirth ≥3) showed no significant association.
Conclusion
In this community-based, cross-sectional study conducted in northeastern Taiwan, the aim was to explore the prevalence of gallstone disease (GSD) and identify independent risk factors, with a specific focus on different obesity indicators for predicting GSD.
Key findings indicated that central obesity, assessed through waist-to-height ratio (WHtR), emerged as a crucial risk factor for GSD in women. Additionally, diabetes mellitus (DM) and exogenous hormone intake were positively associated with GSD in men and women, respectively.
The prevalence of GSD varies across ethnicities and geographic locations, influenced by dietary factors. While the prevalence in this study was 8.8%, lower than Western countries but higher than some East Asian countries, it underscores the impact of dietary habits and lifestyles on GSD prevalence.
Age was identified as an independent risk factor, with GSD prevalence increasing notably in individuals over 60 years. The role of gender in GSD development remains debated, with previous Western studies suggesting higher susceptibility in women, possibly linked to female sex hormones. However, in this study, GSD was more prevalent in men, a distinction potentially influenced by regional and ethnic differences.
Factors such as exogenous hormone use (including hormone replacement therapy and oral contraceptives) were identified as independent risk factors for GSD in women. Multiparity, often considered a factor in gallstone formation due to incomplete gallbladder emptying during pregnancy, did not emerge as a significant risk factor in multivariate analysis.
Metabolic syndrome, characterized by insulin resistance, central obesity, dyslipidemia, and elevated blood pressure, exhibited a well-documented association with GSD. Among its components, lower high-density lipoprotein (HDL), elevated triglycerides, elevated fasting glucose, and increased waist circumference were significantly correlated with GSD prevalence. Notably, DM and central obesity, defined by WHtR ≥0.5, were strong risk factors for GSD.
While various anthropometric indicators have been used to assess obesity’s association with GSD, WHtR emerged as the most accurate predictor in this study, particularly in women. The study highlighted the limitations of other indicators like body mass index (BMI), emphasizing the importance of distinguishing between visceral and subcutaneous fat in assessing GSD risk.
Certain limitations, including the study’s cross-sectional nature and the inability to determine gallstone composition, were acknowledged. Nonetheless, the findings contribute valuable insights, emphasizing the independent associations of central obesity, exogenous hormone use, and DM with GSD, with WHtR identified as a key predictive indicator. These results hold significance for future research, cross-country studies, and preventive strategies for gallstone disease.
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