Association of diabetes, serum insulin, and c-peptide with gallbladder disease

Rühl, Martin; Everhart, James E.

doi:10.1002/hep.510310206

Cited by 167 publications

(114 citation statements)

References 33 publications

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“…Insulin levels were associated with prevalent gallbladder disease in prior studies, whereas leptin levels were not. 27,28 Leptin may mediate secretion of cholesterol into bile by the liver, 29,30 potentially promoting cholesterol lithogenesis in obese patients. We found leptin levels were increased relative to those in nonpregnant women, consistent with known changes in leptin levels during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy†

et al. 2005

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Gallstones are strongly associated with higher parity in women. This study prospectively assessed the incidence, natural history, and risk factors for biliary sludge and stones during pregnancy and the postpartum in 3,254 women at an army medical center. Women with a prior cholecystectomy or with stones at their first study ultrasound were excluded. Gallbladder ultrasound and subject questionnaires were obtained in each trimester and at 4 to 6 weeks postpartum. Serum glucose, lipids, insulin, leptin, estradiol, and progesterone were measured at 26 to 28 weeks' gestation. A nested case-control study was done to examine the effects of serum leptin and insulin on incident gallbladder disease. At least two study ultrasounds were available for 3,254 women. Sludge or stones had been found on at least one study ultrasound in 5.1% by the second trimester, 7.9% by the third trimester, and 10.2% by 4 to 6 weeks postpartum. Regression of sludge and stones was common, such that overall 4.2% had new sludge or stones on the postpartum ultrasound. Twenty-eight women (0.8%) underwent cholecystectomy within the first year postpartum. Prepregnancy body mass index was a strong predictor of incident gallbladder disease (P < .001). Serum leptin was independently associated with gallbladder disease (odds ratio per 1 ng/dL increase, 1.05; 95% CI, 1.01, 1.11), even after adjusting for body mass index. In conclusion, incident gallbladder sludge and stones are common in pregnancy and the postpartum, and cholecystectomy is frequently done within the first year postpartum. Prepregnancy obesity and serum leptin are strong risk factors for pregnancy-associated gallbladder disease. (HEPATOLOGY 2005;41: 359-365.) I n the United States, gallstone disease is the most common and costly of all digestive diseases, requiring more than 700,000 cholecystectomies annually. [1][2][3][4] Both the frequency and number of pregnancies are major risk factors for cholesterol gallstones. 2,5-9 European studies have suggested that new biliary sludge (a precursor to gallstones) and gallstones may form in as many as 31% and 2% of pregnant women, respectively. 10-12 Gallbladder disease is the most common non-obstetrical cause of maternal hospitalization in the first year postpartum. 13 This study prospectively evaluated the incidence and natural history of pregnancy-related gallbladder sludge and stones in the United States and closely examined potential demographic, medical, and behavioral risk factors for their development. Pregnancy may constitute a defined period of metabolic stress in which subclinical tendencies are transiently revealed. For example, pregnant women with gestational diabetes or high blood pressure are at risk of later developing diabetes mellitus or hypertension. 14-18 A similar phenomenon may happen with gallbladder sludge and stones. With careful interpretation, our results also may help clarify risk factors for development of gallbladder disease in the general population. Patients and MethodsConsecutive women attending obstetrics orient...

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Section: Discussionmentioning

confidence: 99%

Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy†

et al. 2005

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“…[5][6][7] One of the most provocative risk factors to emerge during this period has been hyperinsulinemia, the focus of the paper by Ruhl and Everhart in this issue of HEPATOLOGY. 8 Scragg et al 9 were among the first to examine the relation of plasma insulin levels to gallstone risk. In a 1984 hospitalbased case control analysis, they found fasting insulin means to be higher in gallstone cases of both sexes, independent of age and triglyceride levels.…”

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confidence: 99%

“…Finally, a recent ultrasonographic survey from Mexico City found mean fasting insulin levels in women with gallstones to be higher than those of controls, although no relationship was found in men. 14 Ruhl and Everhart 8 have now clarified the relation of insulinemia to gallstones in the large scale, carefully designed third National Health and Nutrition Examination Survey (NHANES III). NHANES III itself is an important milestone in our understanding of gallstone epidemiology.…”

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confidence: 99%

“…In their article published in this issue of HEPATOLOGY, 8 Ruhl and Everhart document positive associations of glucose intolerance, fasting serum insulin levels, and fasting Cpeptide levels with gallbladder disease prevalence in persons not known to have diabetes at the time of the survey. Although these relationships were evident in both sexes in the unadjusted analyses, they were stronger in women.…”

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confidence: 99%

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Cholelithiasis and the insulin resistance syndrome

Diehl

2000

Hepatology

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“…[5] However contradictory results have been reported by some workers who observed no change in prevalence of gallbladder disease in diabetics. [6] Hypomotility of gallbladder is suspected to be the result of autonomic neuropathy. [7] Diabetic neuropathy is the most common neurological complication of diabetes and prevalence has been reported from < 5% to nearly 60% and even 100% if subclinical neuropathy is detected by electrophysiological studies.…”

Section: Introductionmentioning

confidence: 99%