Are incident gallstones associated to sex‐dependent changes with age? A cohort study

Abstract

Age and female sex have repeatedly been identified as gallstone determinants but the underlying mechanisms are not clarified. The objectives of this study were to determine if changes with age in physiology, lifestyle, or reproductive hormones were associated with incident gallstones. A cohort study of a general population random sample (N = 2366) aged 30-60 years was performed. Participants were ultrasound screened for gallstones in 1982-84 and again in 1993-94. Lifestyle data and blood samples were obtained and re-analyzed in 2004. Changes with age in physiology (body mass index, blood pressure, blood lipids, self-rated health), lifestyle (smoking, alcohol and coffee consumption, dietary habits, physical activity level), and indices of reproductive function (number of births, oral contraceptive use, hormone replacement therapy, male reproductive hormones) were explored in females and males separately. Adjusted logistic regression analyses were performed. Incident gallstones (gallstones and cholecystectomy) at ultrasound examination in participants initially free of gallstones at baseline occurred in 9.9% of the study population. In females, increasing alcohol consumption (odds ratio (OR) 0.94, 95% confidence interval (CI) [0.90; 0.98]) and the cessation of hormone replacement therapy (OR 0.29, 95% CI [0.10; 0.83]) inversely determined incident gallstones. In males, increasing levels of SHBG (OR 0.97, 95% CI [0.94; 0.998]) inversely determined incident gallstones. Other changes with age in physiology, lifestyle, or reproductive hormones were not associated. High baseline free testosterone determined incident gallstones in males (OR 1.15, 95% CI [1.02; 1.30]). To conclude, changes with age in alcohol consumption in females and in reproductive hormones determined incident gallstones. Male reproductive hormones seem to have an impact on incident gallstones. Sex differences should be explored further in future studies.

The Effect of Cholecystectomy on the Risk of Colorectal Cancer in Patients with Gallbladder Stones

“…In contrast to the predilection of women for cholecystectomy based on a hospitalization database from the United States, our findings were consistent with a hospitalization-based study conducted in Japan and Taiwan to demonstrate that most patients undergoing cholecystectomy were men [21,22]. Furthermore, the findings with the predisposition of patients aged ≥ 50 years to cholecystectomy were consistent with the liability of the elderly to GBS due to increased biliary cholesterol secretion, impaired bile salt synthesis, poor gallbladder contractility, and increased exposure to pro-lithogenic factors [23,24]. Whereas most individuals with cholecystectomy belonged to the occupation category of a blue collar occupation (52.6%) and lived in the least urbanized area (33.6%), which might be due to the relatively unhealthy lifestyle behaviors [25].…”

Gender specific variation in risk factors of gallstone disease among adult patients

“…15 Consumption of alcohol found to be inversely associated with GSD in females as well as males but it was statistically insignificant, this has been corroborated with other studies, whereas some studies showed that alcohol not associated with GSD in males and inversely associated in females. [18][19][20] Sedentary life style was found to be significant risk factor for the development of GSD in both the sexes, this has been corroborated with other studies, whereas Sun et al found no significant association neither in females nor in males. 4,6,7,18 High BMI and high waist hip ratio were significantly associated with development of GSD in females same results were seen in other studies; but in males we have found no association, whereas as several studies found significant association.…”

Risk of gallstones based on ABCG8 rs11887534 single nucleotide polymorphism among Taiwanese men and women

“…Age and BMI are also independent determinants of gallstones [ 6 , 8 , 9 , 27 , 45 , 46 , 52 – 58 ]. Other reported risk factors for gallstones are family history [ 6 ], abnormal liver function tests including high bilirubin, AST, and ALT [ 54 – 56 , 59 ], and abnormal lipoprotein levels including low HDL-C, high LDL-C, and triglycerides [ 46 , 58 , 60 ].…”