Obesity, dyslipidemia, and diabetes mellitus as risk factors in cholelithiasis
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Department of Internal Medicine, Faculty of Medicine, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Banten, INDONESIA
Faculty of Medicine, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Banten, INDONESIA
Online publication date: 2023-10-19
Publication date: 2023-11-01
Electron J Gen Med 2023;20(6):em549
Cholelithiasis or gallstones has many risk factors, such as age, sex, obesity, dyslipidemia, and diabetes mellitus (DM). Studies in developing country shown that obesity, dyslipidemia, and DM occurred in 55.0%, 76.0%, and 17.7% of adults with cholelithiasis, respectively. The aim of this study is to know the proportion of cholelithiasis risk factors.

Materials & methods:
This retrospective study using descriptive cross sectional design performed in one of the largest referral hospital in Jakarta Indonesia. Demographic data, and laboratory examination were collected from medical record. Patients presented with cholelithiasis from the abdominal ultrasonography was enrolled into study.

93 subjects were selected through consecutive sampling, where in 65.8% were female and 77.5% age>40 years. The majority was obese (47.3%) and the obesity grade I was most prevalent. Dyslipidemia was found in 19.3% subjects with proportion of high total cholesterol was 54.5%, high LDL 90.9%, high triglycerides 27.3%, and low HDL 18.2%. DM was found in 15.0% subjects. Random blood glucose had higher proportion, accounting 57.2% with mean 140.67± 89.69 mg/dl. Female and age>40 years had more proportion in cholelithiasis patients.

Proportion of cholelithiasis with obesity 47.3%, dyslipidemia 19.3%, and diabetes 15.0%. However, the proportion of obesity, dyslipidemia and diabetes in this study was lower than other studies in Asia or developing countries. Patients with obesity grade I, high LDL and RBG>40 mg/dl should be aware to have cholelithiasis.

Tazuma S, Unno M, Igarashi Y, et al. Evidence-based clinical practice guidelines for cholelithiasis. J Gastroenterol. 2017; 52:276-300. https://doi.org/10.1007/s00535... PMid:27942871.
Di Ciaula A, Wang DQ-H, Portincasa P. An update on the pathogenesis of cholesterol gallstone disease. Curr Opin Gastroenterol. 2018;34(2):71-80. https://doi.org/10.1097/MOG.00... PMid:29283909 PMCid:PMC8118137.
Dooley JS, Gurusamy KS, Davidson BR. Gallstones and benign biliary disease. In: Dooley JS, Lok ASF, Garcia-Tsao G, Pinzani M, editors. Sherlock’s diseases of the liver and biliary system. 13th ed. New Jersey, NJ: Wiley-Blackwell; 2018. p. 256-93. https://doi.org/10.1002/978111... PMid:30005938.
Weerakoon H, Navaratne A, Ranasinghe S, Sivakanesan R, Galketiya KB, Rosairo S. Chemical characterization of gallstones: An approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka. PLoS One. 2015;10(4): e0121537. https://doi.org/10.1371/journa... PMid:25853583 PMCid:PMC4390354.
Purnell JQ, FeingoldKR, Anawalt B, et al. Definitions, classification, and epidemiology of obesity. In: Endotext. South Dartmouth, MA: MDText.com, Inc.; 2000.
Kharga B, Sharma BK, Singh VK, et al. Obesity not necessary, risk of symptomatic cholelithiasis increases as a function of BMI. J Clin Diagnostic Res. 2016;10(10):28-32. https://doi.org/10.7860/JCDR/2... PMid:27891394 PMCid:PMC5121732.
Radmard AR, Merat S, Kooraki, S, et al. Gallstone disease and obesity: A population based-study on abdominal fat distribution and gender differences. Ann Hepatol. 2015;14(5):702-9. https://doi.org/10.1016/S1665-... PMid:26256899.
Malik AA, Wani ML, Tak SI, Irshad I, Ul-Hassan N. Association of dyslipidaemia with cholelithiasis and effect of cholecystectomy on the same. Int J Surg. 2011;9(8):641-2. https://doi.org/10.1016/j.ijsu... PMid:21933723.
World Health Organization & International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: Report of a WHO/IDF consultation. World Health Organization; 2021. Available at: https://www.who.int/health-top... (Accessed: 12 March 2023).
Guimaraes S, Gomes H, De Oliveira G, et al. Prevalence of cholelithiasis in patients with type 2 diabetes and obesity in a basic family health centre in Irecê, Northeastern Brazil. Open J Endocr Metab Dis. 2016;6:38-42. https://doi.org/10.4236/ojemd.....
Sodhi JS, Zargar SA, Khateeb S, et al. Prevalence of gallstone disease in patients with type 2 diabetes and the risk factors in North Indian population: A case control study. Indian J of Gastroenterol. 2014;33(6):507-11. https://doi.org/10.1007/s12664... PMid:25283265.
Moghaddam AA, Khorram A, Miri-Bonjar M, Mohammadi M, Ansari H. The prevalence and risk factors of gallstone among adults in South-East of Iran: A population-based study. Glob J Health Sci. 2016;8(4):60-7. https://doi.org/10.5539/gjhs.v... PMid:26573029 PMCid:PMC4873599.
Belal S, Hamed AS, Kamal A, Al- Sayed MAW, El Hamid HMA. Risk factors associated with cholelithiasis during pregnancy and postpartum. Open J Obstet Gynecol. 2022; 12;1166-75. https://doi.org/10.4236/ojog.2....
Wang HH, Liu M, Clegg DJ, et al. New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta. 2009;1791(11):1037-47. https://doi.org/10.1016/j.bbal... PMid:19589396 PMCid:PMC2756670.
Sun H, Warren J, Yip J, et al. Factors influencing gallstone formation: A review of the literature. Biomolecules. 2022;12(4):550. https://doi.org/10.3390/biom12... PMid:35454138 PMCid:PMC9026518.
Kim SB, Kim KH, Kim TN, et al. Sex differences in prevalence and risk factors of asymptomatic cholelithiasis in Korean health screening examinee: A retrospective analysis of multicenter study. Medicine (Baltimore). 2017;96(13): e6477. https://doi.org/10.1097/MD.000... PMid:28353587 PMCid:PMC5380271.
Zhang J, Chen L, Shen K, et al. Association between metabolically healthy overweight/obesity and gallstones in Chinese adults. Nutr Metab (Lond). 2023;20:20. https://doi.org/10.1186/s12986... PMid:37004051 PMCid:PMC10064513.
Parra-Landazury NM, Cordova-Gallardo J, Méndez-Sánchez, N. Obesity and gallstones. Visc Med. 2021;37(5):394-402. https://doi.org/10.1159/000515... PMid:34722722 PMCid:PMC8543292.
Nugraha GI, Tahapary DL, Hidayat RW, et al. The urgency in proposing the optimal obesity cutoff value in Indonesian population. Medicine (Baltimore). 2022;101(49):e32256. https://doi.org/10.1097/MD.000... PMid:36626522 PMCid:PMC9750693.
Harbuwono DS, Pramono LA, Yunir E, Subekti I. Obesity and central obesity in Indonesia: Evidence from a national health survey. Med J Indones. 2018;27(2):114-20. https://doi.org/10.13181/mji.v....
Wang J, Shen S, Wang B, et al. Serum lipid levels are the risk factors of gallbladder stones: A population-based study in China. Lipid Health Dis. 2020;19(1):50. https://doi.org/10.1186/s12944... PMid:32192520 PMCid:PMC7083041.
Atamanalp SS, Keles MS, Atamanalp RS, Acemoglu H, Laloglu E. The effects of serum cholesterol, LDL, and HDL levels on gallstone cholesterol concentration. Pak J Med Sci 2013;29(1):187-90. https://doi.org/10.12669/pjms.....
Kim Y, Oh CM, Ha E, Park SK, Jung JY, Ryoo JH. Association between metabolic syndrome and incidence of cholelithiasis in the Korean population. J Gastroenterol Hepatol. 2021;36(12):3524-31. https://doi.org/10.1111/jgh.15... PMid:34097775 PMCid:PMC9291184.
Shabanzadeh DM, Sørensen LT, Jørgensen T. Determinants for gallstone formation–A new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol. 2016;51(10):1239-48. https://doi.org/10.1080/003655... PMid:27232657.
Ali S, Ahamad ST, Talpur AS, Parajuli S, Farooq J. Prevalence of non-insulin-dependent diabetes mellitus among patients with cholelithiasis: A single-centered, cross-sectional study. Cureus. 2018;10(4):e2444. https://doi.org/10.7759/cureus....
Su PY, Hsu YC, Cheng YF, Kor CT, Su WW. Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years. BMC Gastroenterol. 2019;19:117. https://doi.org/10.1186/s12876... PMid:31272395 PMCid:PMC6610843.
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