Feb. 24, 1999 BUFFALO, N.Y. -- The Western lifestyle of little exercise, lots of saturated fat, loads of refined sugar and little fiber is a major risk factor for the development of yet another chronic medical condition -- gallstones -- a new University at Buffalo study shows.
Published in the February issue of the American Journal of Clinical Nutrition, the study is one of the few population-based investigations of factors affecting the development of gallbladder disease over time.
Results showed that body mass index and intake of refined sugar and saturated fat were directly associated with the formation of gallstones. The relationship between saturated fat and gallstones was stronger in men than in women.
Conversely, physical activity and a diet high in monounsaturated fat and insoluble dietary fiber were protective against gallstones, results showed.
"This study confirms that gallbladder disease is one of the diseases of Western civilization," said epidemiologist Maurizio Trevisan, chair of the UB Department of Social and Preventive Medicine and author of the study.
"It is one more message that a diet high in fat and refined sugar and a pattern of low physical activity can get you into all kinds of trouble."
The results are interesting to epidemiologists, he said, because they support the hypothesis that common pathophysiological mechanisms may underlie the chronic diseases afflicting Western populations. Gallbladder disease is increasingly common with age, and affects more women than men. Twenty percent of women are reported to have gallstones at autopsy.
The study was conducted in the small farming community of Castellana in southern Italy. In 1985 and 1986, researchers administered ultrasound scans of the gallbladder and took blood
samples from 1,429 men and 1,043 women selected randomly from the population. Persons free of gallstones at that time were re-examined by ultrasound between May 1992 and June 1993, and completed questionnaires concerning sociodemographic status, medical history, dietary habits and physical activity.
The 55 men and 49 women who had developed gallstones during the study period then were matched with controls from the study population. These participants provided information on how often they ate certain foods to give a more complete picture of dietary intake.
Analysis of the data from new cases and controls showed that age, body mass index (an indication of obesity) and prevalence of diabetes were higher, while physical activity was lower, in those who developed gallstones than in those who did not. Dieting, caffeine and smoking appeared to have little effect.
Dietary analysis showed that higher intake of monounsaturated fats and higher expenditure of calories lowered the risk of gallstones, while higher consumption of refined sugars and saturated fat were directly related to gallstone formation.
Particularly interesting was the finding that saturated-fat intake appears to have a stronger relationship to gallstone formation in men than women, Trevisan said. Women had higher rates of gallstones at the first three quartiles of saturated fat consumption, but their risk increased slowly as consumption increased. However, the risk doubled for men at each quartile of consumption and at the highest quartile, men were at a higher risk of developing gallstones than women.
"These findings seem to suggest that other factors, such as hormones or metabolism, may be more powerful risk factors for gallstone formation among women than saturated fat intake," Trevisan said.
The research team was headed by Giovanni Misciagna, M.D., chief of the laboratory of epidemiology and biostatistics at the Institute S. De Bellis, a gastroenterology clinical research center in Castellana.
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