Balloon-assisted enteroscopy in portal hypertensive enteropathy.

BACKGROUND/AIMS: Balloon-assisted enteroscopy (BAE) provides higher-resolution of imaging and allows both diagnosis and treatment in the small intestine. However, the role of BAE in portal hypertensive enteropathy (PHE) is not clear. The purpose of this study is to define BAE findings and its utility in patients with PHE. METHODOLOGY: This study included 20 cirrhotic patients with PHE and 20 control patients, matched by age and gender, who underwent BAE. The indications were to investigate the cause of obscure gastrointestinal bleeding and to achieve a diagnosis in patients with abnormal video capsule endoscopy and/ or abnormal radiological imaging. We evaluated the diagnostic yield and safety of BAE in PHE. RESULTS: BAE revealed significantly abnormal small bowel mucosa including angiodysplasia-like lesions, friability, edema, erythema, and punctate hemorrhage in PHE. There was a significantly higher prevalence of small bowel angiodysplasia- like lesions (65%) in the cirrhotic patients as compared with that (10%) in the controls (p = 0.01). Among the patients with small bowel angiodysplasialike lesions (65%), seven patients (35%) exhibited a diffuse pattern, which was not found in the control group (p = 0.008). CONCLUSIONS: Our study has shown that small bowel angiodysplasia-like lesion, particularly, the diffuse form of the lesion, is the dominant mucosal abnormality in PHE.

Hyperinsulinemia, insulin resistance, vitamin D, and colorectal cancer among whites and African Americans.

African Americans have the highest incidence and mortality rates of colorectal cancer among all US racial and ethnic groups. Dietary factors, lifestyle factors, obesity, variability in screening rates, socioeconomic differences, barriers to screening, and differences in access to health care may be contributory factors to racial and ethnic disparities. African Americans are more likely to demonstrate microsatellite instability in their colorectal tumors leading to malignancy. However, these differences do not completely explain all the variances. Ample evidence implicates insulin resistance and its associated conditions, including elevated insulin and insulin-like growth factor-1 (IGF-1), in colorectal carcinogenesis. African Americans have a high risk for and a high prevalence of insulin resistance and subsequent overt type 2 diabetes. Recent clinical studies revealed that ethnic differences between whites and African Americans in early diabetes-related conditions including hyperinsulinemia already exist during childhood. African Americans have a much higher prevalence of vitamin D deficiency than whites throughout their life spans. Vitamin D deficiency has been associated with higher rates of diabetes and colorectal cancer, particularly in individuals with high serum insulin and IGF-1 levels. Moreover, African Americans have lower insulin sensitivity in tissues, independent of obesity, fat distribution, and inflammation. Further development of measures of biomarkers of tumor biology and host susceptibility may provide further insight on risk stratification in African Americans.

Statin use and the risk of cholecystectomy in women.

BACKGROUND & AIMS: Statins can reduce biliary cholesterol secretion independently of their ability to inhibit cholesterol synthesis. Statins also prevent the formation of gallstones in animal studies, although the effect of statins on human gallstone disease has been controversial. METHODS: We examined the relationship between the use of statins and the risk of cholecystectomy in a cohort of US women. As part of the prospective Nurses' Health Study, participants biennially reported their history of gallstone disease and whether they had undergone cholecystectomy. Women also reported lifetime use of statins retrospectively in 2000. We conducted a retrospective analysis of statin using data collected in 2000, to define use from 1994 forward, and a prospective analysis for general lipid-lowering drugs from 1994 to 2004. RESULTS: In the statin analysis we ascertained 2479 cases of cholecystectomy during 305,197 person-years of follow-up evaluation. The multivariate relative risk for current statin users, compared with nonusers, was 0.82 (95% confidence interval, 0.70-0.96). In the analysis of general cholesterol-lowering drugs, we ascertained 3420 cases of cholecystectomy during 511,411 person-years of follow-up evaluation. Compared with nonusers, the multivariate relative risk for current users of general cholesterol-lowering drugs, mostly statins in this cohort, was 0.88 (95% confidence interval, 0.79-0.98). CONCLUSIONS: Statin use appears to reduce the risk of cholecystectomy in women.

Steatocholecystitis and fatty gallbladder disease.

Obesity has become an epidemic worldwide. It is accompanied by a multitude of medical complications including metabolic syndrome. Obesity may lead to fatty infiltration of multiple internal organs including liver, heart, kidney, and pancreas, causing organ dysfunctions. Fatty infiltration leads to chronic inflammation and tissue damage. Fatty infiltration in the liver results in nonalcoholic fatty liver disease, which is increasingly common nowadays. Recent studies in animals and humans indicate that obesity also is associated with fatty infiltration of gallbladder, resulting in cholecystosteatosis. The increased gallbladder lipids include free fatty acids, phospholipids, and triglycerides. Enhanced inflammation with an increased amount of fat in the gallbladder results in an abnormal wall structure and decreased contractility. In support of this notion, a recent experiment on the effect of Ezetimibe, which is a novel drug that inhibits intestinal fat absorption, on fatty gallbladder disease reveals that Ezetimibe can ameliorate cholecystosteatosis and restore in vivo gallbladder contractility. The proportion of cholecystectomies performed for chronic acalculous cholecystitis has increased significantly over the past two decades. An increase in gallbladder fat, which leads to poor gallbladder emptying and biliary symptoms, may partly explain this phenomenon. Although dietary carbohydrates have been demonstrated to be associated with fatty gallbladder disease, other potential modifiable environmental factors are not clear. The pathogenesis and prognosis of fatty gallbladder disease, including steatocholecystitis, and the relations of fatty gallbladder disease to nonalcoholic fatty liver disease, including steatohepatitis, and other components of metabolic syndrome are largely unknown. More research is needed to answer these questions.

Macronutrients and insulin resistance in cholesterol gallstone disease.

Cholelithiasis is a major source of digestive morbidity worldwide. Cholesterol stones account for the majority of gallstones in the United States and other Western countries. The pathogenesis of cholesterol gallstone disease is multifactorial with key factors including cholesterol supersaturation of bile, altered biliary motility, and nucleation and growth of cholesterol crystals. Increasing evidence suggests that many, but not all, causative factors of cholesterol gallstones are related to insulin resistance which, in association with obesity, has reached an epidemic level worldwide. Experimental studies show that hyperinsulinemia, a key feature of insulin resistance, may cause increased hepatic cholesterol secretion and cholesterol supersaturation of bile and gallbladder dysmotility, and thereby may enhance gallstone formation. Insulin resistance syndrome can be modified by environmental factors, including dietary factors. The impact of diet on insulin sensitivity is mediated by both dietary composition and its energy content. The contribution of specific dietary elements to the prevalence and incidence of cholesterol gallstone disease has been explored in animal and human studies. There is considerable evidence to suggest that different types of fatty acids, independent of the total amount of fat consumption, affect insulin sensitivity and cholesterol gallstone disease differently. The effects of salt intake, consumption of protein and carbohydrates, and alcohol drinking on insulin resistance are controversial. Additional intervention trials and controlled experimental feeding studies are needed to further clarify these relationships and to provide useful prophylactic and therapeutic strategies.

Heme and non-heme iron consumption and risk of gallstone disease in men.

BACKGROUND: Excessive iron intake can promote biliary cholesterol crystal formation in experimental studies. The absorption of heme iron is more complete than that of non-heme iron in humans; however, the effect of long-term consumption of heme and non-heme iron on the risk of gallstones is unknown. OBJECTIVE: The objective of the study was to examine long-term iron intake in relation to the occurrence of gallstone disease. DESIGN: We prospectively studied intakes of heme and non-heme iron and the risk of gallstone disease in a cohort of 44 758 US men from 1986 to 2002. Iron consumption was assessed by using a validated semiquantitative food-frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially. RESULTS: We documented 2468 incident cases of symptomatic gallstones during 597 699 person-years of follow-up. The age-adjusted relative risks (RRs) for men with intakes of heme iron and non-heme iron, when the highest and lowest quintiles were compared, were 1.21 (95% CI: 1.06, 1.37; P for trend = 0.0008) and 1.02 (95% CI: 0.90, 1.16; P for trend = 0.45), respectively. After adjustment for multiple potential confounding variables, when extreme quintiles were compared, the multivariate RR of heme iron intake was not significantly changed and remained significant with a dose-response relation (RR = 1.21; 95% CI: 1.03, 1.42; P for trend = 0.01), and that of non-heme iron intake was not significant (RR = 1.14; 95% CI: 0.99, 1.31; P for trend = 0.18). CONCLUSION: Our findings suggest that a higher consumption of heme iron is associated with a greater risk of gallstone disease among men.

Weight cycling and risk of gallstone disease in men.

BACKGROUND: The long-term effect of repeated intentional weight loss and weight regain on the risk of gallstone disease in men is not clear. METHODS: Participants in the Health Professionals Follow-up Study provided information on intentional weight loss during the previous 4 years in 1992. Weight cyclers were men who had intentional weight loss and weight regain. Men free of gallstone disease at baseline were followed from 1992 to 2002. On biennial questionnaires the participants reported newly diagnosed gallstone disease. RESULTS: During 264,760 person-years of follow-up we ascertained 1222 cases of symptomatic gallstones. We examined the effect of weight cycling on the risk of gallstone disease. The multivariate relative risk of weight cyclers, compared with weight maintainers, after adjusting for potential confounding variables, including body mass index, was 1.11 (95% confidence interval [CI], 0.94-1.31) in light cyclers, 1.18 (95% CI, 0.97-1.43) in moderate cyclers, and 1.42 (95% CI, 1.11-1.81) in severe cyclers. We further examined the effect of number of cycling episodes. Among weight cyclers, the relative risk associated with having more than 1 weight cycle, compared with weight maintainers, was 1.10 (95% CI, 0.88-1.37) in light cyclers, 1.28 (95% CI, 1.03-1.59) in moderate cyclers, and 1.51 (95% CI, 1.13-2.02) in severe cyclers. CONCLUSIONS: Our findings suggest that weight cycling, independent of body mass index, may increase the risk of gallstone disease in men. Larger weight fluctuation and more weight cycles are associated with greater risk.

Long-term intake of trans-fatty acids and risk of gallstone disease in men.

BACKGROUND: The consumption of trans-fatty acids adversely affects blood lipid levels. The relationship with the incidence of gallstone disease is unknown. METHODS: We prospectively studied consumption of trans-fatty acids in relation to the risk of gallstone disease in a cohort of 45,912 men. trans-Fatty acid consumption was assessed using a validated semiquantitative food frequency questionnaire. Newly diagnosed gallstone disease, by radiology or cholecystectomy, was ascertained biennially. RESULTS: During 14 years of follow-up, we documented 2356 new cases of symptomatic gallstones. After adjusting for age and other potential risk factors, we found that compared with men in the lowest quintile of dietary intake of trans-fatty acids, the relative risk (RR) of gallstone disease for those in the highest quintile was 1.23 (95% confidence interval [CI], 1.04-1.44; P for trend, .03). Among individual trans-fatty acids, the RR for trans-oleic fatty acid, when extreme quintiles were compared, was 1.24 (95% CI, 1.06-1.45; P for trend, .02). Intakes of trans-palmitoleic fatty acid (RR, 1.09; 95% CI, 0.90-1.31), trans,trans 18:2 fatty acid (RR, 1.14; 95% CI, 0.96-1.34), and cis-trans 18:2 fatty acid (RR, 1.00; 95% CI, 0.86-1.16) were not significantly associated with the risk. CONCLUSIONS: Our results suggest that a higher intake of trans-fatty acids modestly increases risk of gallstone disease. This adds to the concern that partial hydrogenation of vegetable oils to form shortening and margarine can lead to adverse health effects.

Thiazide diuretics and the risk of gallbladder disease requiring surgery in women.

BACKGROUND: Previous studies have suggested that thiazide diuretic use increases the risk of cholecystitis. METHODS: We prospectively examined the association between thiazide use and cholecystectomy, a surrogate for symptomatic cholelithiasis, in a cohort of 81 351 US women who were aged 30 to 55 years in 1980 and followed up to 2000. Regular use of thiazide diuretics was assessed at baseline by asking the participants to report whether they currently took "any of the following medications in most weeks" and listing "thiazide diuretics (eg, Diuril and Hydrodiuril)" among other drugs. Respondents were also requested to report the duration of thiazide diuretic use. Assessment of thiazide diuretic use was updated in 1982, 1988, 1994, 1996, and 1998. Cox regression was used to adjust simultaneously for other potential risk factors for cholecystectomy. RESULTS: During follow-up, 8607 women reported undergoing a cholecystectomy. A modest positive relation between the use of thiazide diuretics and cholecystectomy was observed. Compared with never users of thiazide diuretics, the multivariate relative risk of cholecystectomy for past users was 1.16 (95% confidence interval,1.08-1.24) and the multivariate relative risk for current users was 1.39 (95% confidence interval, 1.29-1.50). CONCLUSIONS: These findings are compatible with the hypothesis that the use of thiazide diuretics increases the risk of symptomatic cholecystitis. However, we cannot rule out the possibility that our results are in part explained by unconsidered factors related to the indication for antihypertensive therapy or by differences in medical surveillance between users and nonusers of thiazide diuretics.

The effect of long-term intake of cis unsaturated fats on the risk for gallstone disease in men: a prospective cohort study.

BACKGROUND: Monounsaturated and polyunsaturated fats act as inhibitors of cholesterol cholelithiasis in animal experiments. OBJECTIVE: To examine the association between long-term intake of cis unsaturated fats and the incidence of gallstone disease in humans. DESIGN: Prospective population-based cohort study. SETTING: The Health Professional Follow-up Study. PARTICIPANTS: 45,756 men, age 40 to 75 years in 1986, who were free of gallstone disease. MEASUREMENTS: Consumption of cis unsaturated fats was assessed starting in 1986 as part of the 131-item semi-quantitative food-frequency questionnaires. Questionnaires were mailed to participants every 2 years. The main outcome measure was self-reported newly diagnosed symptomatic gallstone disease. RESULTS: During 14 years of follow-up, 2323 new cases of gallstone disease were documented. After adjustment for age and other potential risk factors, the relative risk for gallstone disease among men in the highest quintile of dietary intake of cis unsaturated fats compared with men in the lowest quintile was 0.82 (95% CI, 0.69 to 0.96; P for trend = 0.006). The relative risk among men in the highest quintile of polyunsaturated fat consumption compared with men in the lowest quintile was 0.84 (CI, 0.73 to 0.96; P for trend = 0.01), and the relative risk among men in the highest quintile of monounsaturated fat consumption compared with men in the lowest quintile was 0.83 (CI, 0.70 to 1.00; P for trend = 0.01). LIMITATIONS: Outcomes were restricted to men with cholecystectomy or diagnostically confirmed but unremoved symptomatic gallstones. CONCLUSIONS: A high intake of polyunsaturated and monounsaturated fats in the context of an energy-balanced diet is associated with a reduced risk for gallstone disease in men. For definitions of terms used in the text, see Glossary.

Prospective study of abdominal adiposity and gallstone disease in US men.

BACKGROUND: Obesity is an established risk factor for gallstones, but whether abdominal adiposity contributes independently to the risk, particularly in men, remains unclear. OBJECTIVE: The purpose of the study was to examine the associations of abdominal circumference and waist-to-hip ratio, as measures of abdominal adiposity, with the risk of symptomatic gallstone disease in men. DESIGN: We prospectively studied measures of abdominal obesity in relation to the incidence of symptomatic gallstone disease in a cohort of 29 847 men who were free of prior gallstone disease and who provided complete data on waist and hip circumferences. Data on weight, height, and waist and hip circumferences were collected in 1986 and in 1987 through self-administered questionnaires. As part of the Health Professionals Follow-Up Study, men reported newly diagnosed symptomatic gallstone disease on questionnaires mailed to them every 2 y. RESULTS: We documented 1117 new cases of symptomatic gallstone disease during 264 185 person-years of follow-up. After adjustment for body mass index and other known or suspected risk factors for gallstones, men with a height-adjusted waist circumference > or = 102.6 cm (40.4 in) had a relative risk of 2.29 (95% CI: 1.69, 3.11; P for trend < 0.001) compared with men with a height-adjusted waist circumference < 86.4 cm (34 in). Men with a waist-to-hip ratio > or = 0.99 had a multivariate relative risk of 1.78 (1.38, 2.28; P for trend < 0.001) compared with men with a waist-to-hip ratio < 0.89. CONCLUSIONS: Our data suggest the presence of a significant association between abdominal adiposity and the incidence of symptomatic gallstone disease. As measures of abdominal adiposity, abdominal circumference and waist-to-hip ratio predict the risk of developing gallstones independently of body mass index.

Frequent nut consumption and decreased risk of cholecystectomy in women.

BACKGROUND: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. OBJECTIVE: The association between nut intake and cholecystectomy was examined in a large cohort of women. DESIGN: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy in a cohort of 80,718 women from the Nurses' Health Study who were 30-55 y old in 1980 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 y both their consumption of nuts and whether they had undergone cholecystectomy. The women were followed through 2000. RESULTS: During 1,393,256 person-years of follow-up from 1980 to 2000, we documented 7831 cholecystectomies. After adjustment for age and other known or suspected risk factors, women who consumed > or =5 units of nuts (1 unit = 1 oz or 28.6 g nuts)/wk (frequent consumption) had a significantly lower risk of cholecystectomy (relative risk: 0.75; 95% CI: 0.66, 0.85; P for trend < 0.0001) than did women who never ate nuts or who ate <1 unit/mo (rare consumption). Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were associated with a lower risk of cholecystectomy. CONCLUSION: In women, frequent nut consumption is associated with a reduced risk of cholecystectomy.

Alcohol consumption in relation to risk of cholecystectomy in women.

BACKGROUND: Alcohol consumption has been linked to a lower risk of gallstone disease. However, the magnitude of the association is uncertain, and little is known about the relation of alcohol consumption patterns and individual types of alcoholic beverages to gallstone disease risk. OBJECTIVE: We prospectively examined the association between alcohol intake and cholecystectomy, a surrogate for symptomatic gallstone disease, in a large cohort of women. DESIGN: Women from the Nurses' Health Study who had no history of gallstone disease in 1980 (n = 80,898) were followed for 20 y. Alcohol consumption, which was measured every 2-4 y by food-frequency questionnaires, was used to predict subsequent cholecystectomy through multivariate analysis. RESULTS: We ascertained 7831 cases of cholecystectomy. Relative to subjects who had no alcohol intake, subjects who had alcohol intakes of 0.1-4.9, 5.0-14.9, 15.0-29.9, 30.0-49.9, and >/=50.0 g/d had multivariate relative risks of cholecystectomy of 0.95, 0.86, 0.80, 0.67, and 0.62 (95% CI: 0.49, 0.79), respectively. Relative to subjects who never consumed alcohol, subjects who consumed alcohol 1-2, 3-4, 5-6, and 7 d/wk had multivariate relative risks of cholecystectomy of 0.94, 0.88, 0.87, and 0.73 (0.63, 0.84), respectively. All alcoholic beverage types were inversely associated with cholecystectomy risk, independent of consumption patterns (for quantity of alcohol consumed, P = 0.04, 0.001, and 0.003 for wine, beer, and liquor, respectively; for frequency of alcohol consumption, P = 0.01, 0.07, and <0.0001 for wine, beer, and liquor, respectively). CONCLUSIONS: The intake of all alcoholic beverage types is inversely associated with the risk of cholecystectomy. Recommendations regarding the benefit of consuming moderate quantities of alcohol should be weighed against the potential health hazards.

Impact of balloon-assisted enteroscopy on the diagnosis and management of suspected and established small-bowel Crohn's disease.

BACKGROUND AND AIMS: The role of recently developed balloon-assisted enteroscopy (BAE) in small-bowel Crohn's disease (CD) is not well established. The purpose of this study is to determine the clinical impact of BAE on patients with suspected and established small-bowel CD. METHODS: This study included 22 patients (group A) with suspected small-bowel CD and 43 patients (group B) with established small-bowel CD with or without previous surgery, who underwent BAE, in a prospective BAE registry of a US academic medical institution. All underwent abdominal imaging studies including computed tomography (CT) or magnetic resonance (MR) enterography before BAE. The main outcome measurements were diagnostic yield and clinical outcomes. RESULTS: In total, 78 BAE procedures were carried out in 65 patients. In group A (n = 22, 25 BAE procedures), enteroscopy led to a diagnosis of CD in six patients (27.3 %). Non-steroidal anti-inflammatory drug-related enteropathy was diagnosed in three patients (13.6 %), whereas no lesions were found in the remaining 13 patients. In group B (n = 43, 53 BAE procedures) enteroscopy revealed active intestinal inflammation with ulcers and/or luminal stenosis in 18 patients (41.9 %), which led to a change and escalation of medical therapy. Five patients without active ulcers underwent successful dilation of small-bowel strictures with resulting resolution of obstructive symptoms. Of the 78 BAE procedures, two patients (2.6 %) had bleeding complications which were successfully treated conservatively. One patient (1.3 %) underwent surgery due to procedure-related perforation. CONCLUSIONS: The use of BAE may help improve management in patients with suspected and established small-bowel CD.

Pneumatosis intestinalis in a patient with recurrent Clostridium difficile infection.

A 65-year-old man with long-standing diarrhoea, recurrent Clostridium difficile infection (CDI) in the previous 5 months presented to the gastroenterology clinic with recurrent diarrhoea and abdominal cramping. Physical examination was negative for signs of acute abdomen. Stool C difficile PCR was positive. Abdominal imaging demonstrated an extensive pneumatosis intestinalis involving the small bowel and a dilated small bowel loop. He was treated conservatively with oral vancomycin for recurrent CDI with resolution of diarrhoea and abdominal cramping on 1-month follow-up visit.

Long-chain saturated fatty acids consumption and risk of gallstone disease among men.

BACKGROUND: Various saturated fatty acids have different effects on blood lipids and insulin secretion in experiments. The effect of long-term consumption of specific and different classes of saturated fatty acids on the risk of gallstone disease in humans is unknown. METHODS: We prospectively studied consumption of saturated fatty acids and risk of gallstone disease in a cohort of 44,524 US men from 1986 to 2002. Intake of saturated fatty acids was assessed using a validated semiquantitative food frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially. RESULTS: During 584,679 person-years of follow-up, we documented 2350 incident cases of gallstone disease, of which 1387 cases required cholecystectomy. Compared with men in the lowest quintile of dietary intake of long-chain saturated fats, after adjustment for age and other potential risk factors, the relative risk of gallstone disease for men in the highest quintile was 1.24 [95% confidence interval (CI), 1.02, 1.50, P for trend = 0.03], and the relative risk of cholecystectomy for men in the highest quintile was 1.41 (CI, 1.09, 1.82, P for trend = 0.008). Consumption of medium-chain saturated fatty acids or short-chain saturated fatty acids was unrelated to the risk. CONCLUSIONS: Our results suggest that a higher consumption of long-chain saturated fatty acids may enhance the risk of gallstone disease in men.

Long-term effect of magnesium consumption on the risk of symptomatic gallstone disease among men.

BACKGROUND: Magnesium deficiency can cause dyslipidemia and insulin hypersecretion, which may facilitate gallstone formation. However, the effect of long-term consumption of magnesium on the risk of gallstone disease is unknown. METHODS: We prospectively studied magnesium consumption and risk of gallstone disease in a cohort of 42,705 U.S. men from 1986 to 2002. Magnesium consumption was assessed using a validated semiquantitative food frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially. RESULTS: We documented 2,195 incident cases of symptomatic gallstones during 560,810 person-years of follow-up. The age-adjusted relative risks (RRs) for men with total magnesium intake and dietary magnesium, when the highest and lowest quintiles were compared, were 0.67 (95% confidence interval [CI] 0.59-0.77, P for trend <0.0001) and 0.67 (CI 0.59-0.76, P for trend <0.0001), respectively. After adjusting for multiple potential confounding variables, when extreme quintiles were compared, the multivariate RR of total magnesium intake (RR 0.72, CI 0.61-0.86, P for trend = 0.006) and dietary magnesium (RR 0.68, CI 0.57-0.82, P for trend = 0.0006) remained significant with a dose-response relationship. CONCLUSIONS: Our findings suggest a protective role of magnesium consumption in the prevention of symptomatic gallstone disease among men.

Fruit and vegetable consumption and risk of cholecystectomy in women.

PURPOSE: Many constituents of fruits and vegetables may reduce the risk for gallstones, but prospective data relating fruit and vegetable intake to gallstone disease are sparse. METHODS: We prospectively studied fruit and vegetable consumption in relation to the risk of cholecystectomy in a cohort of 77,090 women in the Nurses' Health Study, 37 to 64 years of age, who had no history of gallstone disease. Women reported on follow-up questionnaires both their consumption of fruits and vegetables and whether they had undergone cholecystectomy. RESULTS: During 1,060,033 person-years of follow-up from 1984 to 2000, participants reported 6608 cases of cholecystectomy. After adjusting for established or suspected risk factors, the relative risk for women in the highest quintile of overall consumption of fruits and vegetables was 0.79 (95% confidence interval [CI], 0.73-0.87, P for trend<.0001) compared with those in the lowest quintile. Similar results were seen for both total fruits and total vegetables separately. The composite items of fruits and vegetables including green leafy vegetables, citrus fruits, vitamin C-rich fruits and vegetables, and cruciferous vegetables also were each inversely associated with the risk. CONCLUSIONS: Our findings suggest a protective role of greater fruit and vegetable consumption against risk of cholecystectomy in women.

Glycemic load, glycemic index, and carbohydrate intake in relation to risk of cholecystectomy in women.

BACKGROUND & AIMS: High-carbohydrate diets with a high glycemic response may exacerbate the metabolic consequences of the insulin-resistance syndrome. The effect on the incidence of gallstone disease is not clear. METHODS: We examined the associations between high-carbohydrate diets with a high glycemic response and the risk of cholecystectomy in a cohort of women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 years both their carbohydrate intake and whether they had undergone cholecystectomy. RESULTS: During 16 years of follow-up, we ascertained 5771 new cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, the relative risk for the highest compared with the lowest quintile of dietary carbohydrate was 1.35 (95% CI: 1.17-1.55, P for trend < .0001). The relative risks for the highest compared with the lowest quintile were 1.50 for glycemic load (95% CI: 1.32-1.71, P for trend < .0001) and 1.32 for glycemic index (95% CI: 1.20-1.45, P for trend < .0001). Independent positive associations were also seen for intakes of starch and sucrose. CONCLUSIONS: Our findings suggest that a higher intake of carbohydrate, dietary glycemic load, and glycemic index may enhance risk of cholecystectomy in women.