Cholesterol cholelithiasis: part of a systemic metabolic disease, prone to primary prevention

Physicochemical analysis of beef tallow and its liquid fraction, comparing frying performance with high oleic acid rapeseed oil and rice bran oil

Fractionation allows the separation of components in beef tallow. This study compared the physicochemical characteristics and cholesterol content of beef tallow and its liquid fraction, evaluating their frying performance as potential deep-fat frying oils against plant oils. Results showed effective separation of unsaturated components from beef tallow through fractionation. Beef tallow exhibited superior physicochemical properties during frying, with lower deterioration levels than plant oils. Benzo[a]pyrene content increased in plant oils but remained low in beef tallow and its liquid fraction. The liquid fraction had a significantly shorter oxidative induction time of 0.38 h compared to 5.85 h and 5.24 h for plant oils. This study revealed that alterations were observed in beef tallow and its liquid fraction when used as frying oils, with beef tallow demonstrating stronger antioxidative properties compared to the liquid fraction, which exhibited lower levels of cholesterol and saturated fatty acids.

Association between relative fat mass and risk of gallstones in adults

Gallstones (GS) are closely associated with obesity. The body mass index (BMI) is the most commonly used index for evaluating obesity. However, BMI does not consider the distribution of adipose tissue and does not differentiate between differences in fat distribution by sex; therefore, BMI only provides a rough indication of overweight status. Relative fat mass (RFM) is an emerging, simple, and low-cost anthropometric index that reflects obesity (particularly abdominal obesity), and is associated with various obesity-related diseases. However, the relationship between the RFM and GS has not yet been explored. Therefore, this study aimed to evaluate the relationship between RFM and the risk of developing GS, the age of patients at the time of their first GS surgery, and to evaluate the predictive value of RFM for the risk of developing GS. Data from the National Health and Nutrition Examination Survey (2017-2020) were used. Logistic regression and dose-response curves were used to analyze the relationship between RFM levels and the prevalence of GS. Multiple linear regression and dose-response curves were used to analyze the relationship between RFM levels and patient age at the time of the first GS surgery. Subgroup analyses further explored the relationship between RFM and age, sex, race, hypertension, and diabetes mellitus. Receiver operating characteristic (ROC) curves were used to analyze the predictive ability of RFM for GS development. Overall, 7978 adults aged ≥ 20 years were included in this study, of whom 828 had a history of GS. After adjusting for potential confounders, each 1-unit increase in RFM was associated with a 9% increase in GS prevalence (odds ratio: 1.09, 95% confidence interval : 1.07, 1.11), with dose-response curves confirming a positive, nonlinear correlation. And the threshold for the effect of RFM on the prevalence of GS was 40.99. Subgroup analyses revealed that the positive correlation between RFM and GS prevalence remained stable in all populations despite subtle differences. The results of the ROC curves suggested that the predictive value of RFM for GS prevalence was superior to that of BMI. In addition, dose-response curves revealed a nonlinear relationship between RFM and patient age at the time of the first GS surgery, and the threshold for the effect of RFM on age at the first GS surgery was 30.99. RFM is closely associated with GS, and in general, higher levels of RFM are associated with a higher risk of GS. RFM is a better predictor of the risk of GS than BMI. Due to the nature of this cross-sectional study, we were unable to determine a causal relationship between the two.

Association of dietary quality indicators with gallstones in the US: NHANES 2017-2020

BACKGROUND

While dietary factors are known to influence gallstone development, the specific relationships between comprehensive dietary quality indicators and gallstone risk remain poorly understood. This study aimed to explore the association between dietary quality indicators and gallstones using data from the 2017 to 2020 US National Health and Nutrition Examination Survey (NHANES).

METHODS

A total of 6,623 US adults were extracted from the 2017-2020 NHANES, of which 734 participants self-reported having gallstones. Dietary quality indicators were assessed using 24-hour dietary recall data. We used multivariate logistic regression analysis to evaluate the association between dietary quality indicators and the likelihood of gallstones. To delineate the non-linear relationships and threshold effects, we utilized a restricted cubic spline (RCS) regression model. Subgroup analyses were also performed.

RESULTS

After adjusting for sex, age, race, education, poverty-to-income ratio, body mass index, large weight loss, alcohol use, smoking, physical activity, diabetes, hypertension, heart failure, coronary heart disease, angina pectoris, heart attack, total calories, total cholesterol, estrogen use, antihyperglycemic drug use, statin use, and glucocorticosteroid use (Model 4), a higher Dietary Inflammatory Index (DII) and lower Alternative Healthy Eating Index (AHEI), Healthy Eating Index (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MED) were all significantly associated with gallstones. Further RCS analysis revealed a nonlinear relationship between the DII and gallstones, with a threshold value of 1.842. Above this threshold, for each unit increase in the DII score, the odds of developing gallstones increased by 27.5%. Subgroup analysis demonstrated that this association was consistent across all subgroups.

CONCLUSION

Participants with gallstones exhibited poor dietary habits. Adopting a diet that reduces inflammation and supports overall health may help lower the risk of gallstone development, with potential implications for dietary recommendations in clinical practice.

Ultrasonographic assessment of gastric and gallbladder dynamics in human health and disease

The diagnosis of functional disorders of the upper gastrointestinal tract relies on clinical evaluation after exclusion of most frequent organic diseases. Diagnostic techniques contribute to better characterization of disease, choice of specific therapy, and follow-up. Functional ultrasonography was introduced in the early '80 s for the non-invasive study of gastric and gallbladder emptying without ionizing radiation, during fasting and postprandially. This technique detects dysfunctional motility in several gastrointestinal and systemic conditions, and can be used along with the assessment of real-time satiety and gastrointestinal symptoms after food ingestion, and dosing of hormones involved in the modulation of gastrointestinal and metabolic homeostasis. Functional ultrasonography has been increasingly used to explore the gastrointestinal pathophysiology, the gut-brain interaction, the effects of drugs (such as antidiabetics), the response to specific dietary and feeding patterns, and to support the development of nutraceuticals. In this evolving scenario, ultrasonography stands as a widely available, highly sustainable, non-invasive, repeatable, safe and low-cost tool, as compared with more expensive, less sustainable or still scarcely standardized procedures to study gastric and gallbladder motility as scintigraphy, wireless motility capsule tests, 13C breath tests, or magnetic resonance imaging. Functional ultrasonography not only provides reliable data in experimental protocols, but also in the assessment of clinical conditions as dyspeptic symptoms, diabetes, gastroenteric and neurological diseases, critical illness, and as a benchmark to evaluate the gastrointestinal effects of innovative drugs.

Association between sleep and gallstone disease in United States adults: A cross-sectional study

BACKGROUND

Both gallstone disease and sleep disorders are important public health problems. Few studies to date have investigated the associations between sleep and gallstone disease in humans. This study aimed to assess whether sleep factors (sleep time, sleep amounts, trouble sleeping) were associated with gallstone disease in the United States adults.

METHODS

This was a population-based cross-sectional study of US adults, which included data of participants aged over 20 years from the National Health and Nutrition Examination Survey (NHANES) gathered between 2017 and March 2020. The assessment of gallstone disease and sleep factors was based on self-reported data. We used sample-weighted logistic regression and restricted cubic spline models to explore the associations between sleep factors and gallstone disease. Subgroup analyses were conducted to assess the interaction between trouble sleeping and interacting factors.

RESULTS

The prevalence of gallstone disease was 11% among the 9,210 adult participants. Going to bed late on weekdays (OR, 1.41; 95% CI, 1.15 to 1.74) and weekends (OR, 1.43; 95% CI, 1.14 to 1.78), and short sleep duration on weekdays (OR, 1.29; 95% CI, 1.00 to 1.68) were factors associated with increased risk of gallstone disease, and we detected dose-response associations with the restricted cubic spline model (RCS) models, after adjusting for confounders. Presenting trouble sleeping was associated with increased risk of gallstone disease (OR, 1.52; 95% CI, 1.03 to 2.23) and the association was influenced by the presence of thyroid disease (P for interaction = 0.037).

CONCLUSIONS

Our study results indicate that going to bed late, short sleep duration, and trouble sleeping were associated with increased risk of gallstone disease in a nationally representative sample of adults in the US.

Gamma-glutamyl transferase to aspartate aminotransferase ratio (GSR) predicts prognoses in patients with colorectal cancer with liver metastasis after microwave ablation

BACKGROUND

Microwave ablation (MWA) is widely used to eliminate colorectal liver metastases (CRLM). However, the risk of tumor recurrence is difficult to predict due to lack of reliable clinical and biological markers. Elevation of gamma-glutamyl transferase (GGT) and aspartate transaminase (AST) provides signals for liver inflammation and cancer progression. The present study evaluated the association between pre-ablation GGT to AST ratio index (GSR) and hepatic recurrence in patients with CRLM after MWA.

METHODS

A retrospectively analyzed 192 CRLM patients who underwent MWA from January 2013 to December 2017. Pre-ablation GSR was classified into high (≤ 2.34) or low (> 2.34) using the upper quartile value. The prognostic value of GSR and other risk factors for liver progression-free survival (LPFS) and cancer-specific survival (CSS) were evaluated by univariate and multivariate analyses.

RESULTS

High GSR was significantly associated with males (P = 0.041), the presence of cholelithiasis (P = 0.012), but not pre-ablation chemotherapy (P = 0.355), which caused significantly increased levels of GGT (P = 0.015) and AST (P = 0.008). GSR showed a significant association with LPFS and CSS through univariate analysis (P = 0.002 and 0.006) and multivariate analysis (P = 0.043 and 0.037). The subgroup analysis demonstrated no interaction between GSR and all variables except for distribution in the sub-analysis of LPFS.

CONCLUSIONS

Our findings suggest that the pre-ablation GSR can be considered as a promising prognostic indicator for poor prognosis of patients with CRLM underwent MWA.

TRIAL REGISTRATION

Not applicable.

Sex disparities in gallstone disease: insights from the MAUCO prospective population-based cohort study

OBJECTIVE

To investigate factors associated with the prevalence and incidence of gallstone disease (GSD) in women and men of the MAUCO population-based prospective cohort.

DESIGN

8948 MAUCO participants (aged 38-74 years) underwent abdominal ultrasound at baseline (2015-2019); 4385 received follow-up ultrasound at years 2 or 4. Factors associated with prevalent GSD were assessed using Poisson multiple regression and with incident GSD using Cox regression models.

RESULTS

GSD prevalence was 40.4% in women (13.1% gallstones, 27.3% cholecystectomies) and 17.1% in men (8.9% gallstones, 8.2% cholecystectomies). In men, GSD prevalence rate ratio (PRR) by age in >64 years was 3.85 (95% CI 3.00 to 4.94), doubling that of women's PRR 1.78 (95% CI 1.57 to 2.01). In women, waist circumference and diabetes were stronger GSD factors; a higher number of children and worse metabolic and socioeconomic conditions were also highlighted. GSD men had higher cardiovascular disease and a family history of GSD and gallbladder cancer. 198 GSD cases developed during follow-up, with incidence increasing by 2% (95% CI 1.005% to 1.03%) per each centimetre above the ideal waist circumference, statistically significant only in women. In men, age was the strongest factor for incidence, followed by a family history of GSD and low high-density lipoprotein increased incidence risk.

CONCLUSIONS

GSD burden was high in this population; a third of women had their gallbladder removed, which may pose them at risk of other health problems. Abdominal obesity was the only preventable GSD risk factor, highlighting the need for effective public health policies promoting obesity reduction.

Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and gallstones among US adults aged ≤ 50 years: a cross-sectional study from NHANES 2017-2020

BACKGROUND

The chronic digestive condition gallstones is quite common around the world, the development of which is closely related to oxidative stress, inflammatory response and abnormalities of lipid metabolism. In the last few years, as a novel biomarker of lipid metabolism, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has garnered significant interest. However, its relationship with gallstones has not been studied yet.

METHODS

3,772 people, all under 50, were included in this study, and their full data came from the National Health and Nutrition Examination Survey (NHANES) database for the years 2017-2020. Information on gallstones was obtained through self-reported questionnaires. Smoothed curve fitting multifactorial logistic regression was utilized to evaluate the connection of NHHR with gallstone formation incidence. Subsequently, subgroup analysis and interaction tests were applied. Finally, to create a prediction model, logistic regression and feature screening by last absolute shrinkage and selection operator (LASSO) were used. The resulting model was displayed using a nomogram.

RESULTS

In multivariate logistic regression that accounted for all factors, there was a 77% increase in the likelihood of gallstones for every unit rise in lnNHHR (OR 1.77 [CI 1.11-2.83]). Following NHHR stratification, the Q4 NHHR level was substantially more linked to the risk of gallstones than the Q1 level (OR 1.86 [CI 1.04-3.32]). This correlation was stronger in women, people under 35, smokers, abstainers from alcohol, non-Hispanic White people, those with excessively high cholesterol, people with COPD, and people without diabetes. After feature screening, a predictive model and visualized nomogram for gallstones were constructed with an AUC of 0.785 (CI 0.745-0.819), which was assessed by DCA to be clinically important.

CONCLUSION

In the group of people ≤ 50 years of age, elevated NHHR levels were substantially linked to a higher incidence of gallstones. This correlation was stronger in several specific groups such as females, under 35 years of age, smokers, and so on. Predictive models constructed using the NHHR have potential clinical value in assessing gallstone formation.

Predictive value of bile acids as metabolite biomarkers for gallstone disease: A systematic review and meta-analysis

BACKGROUND

The profiles of bile acids (BAs) in patients with gallstone disease (GSD) have been found to be altered markedly though in an inconsistent pattern. This study aims to characterize the variation of the BA profiles in GSD patients, thereby to discover the potential metabolite biomarkers for earlier detection of GSD.

METHODS

Literature search of eight electronic database in both English and Chinese was completed on May 11, 2023. The qualitative and quantitative reviews were performed to summarize the changes of BA profiles in GSD patients compared with healthy subjects. The concentrations of BAs were adopted as the primary outcomes and the weighted mean differences (WMDs) and 95% confidence interval (CI) were generated by random-effects meta-analysis models.

RESULTS

A total of 30 studies were enrolled which included 2313 participants and reported the 39 BAs or their ratios. Qualitative review demonstrated serum Taurocholic Acid (TCA), Glycochenodeoxycholic acid (GCDCA), Glycocholic acid (GCA), Taurochenodeoxycholic acid (TCDCA), Glycodeoxycholic acid (GDCA) and Deoxycholic acid (DCA) were significantly increased in GSD patients compared with healthy subjects. Meta analysis was performed in 16 studies and showed that serum Total BAs (TBA) (WMD = 1.36μmol/L, 95%CI = 0.33; 2.4) was elevated however bile TBA (WMD = -36.96mmol/L, 95%CI = -52.32; -21.6) was declined in GSD patients. GCA (WMD = 0.83μmol/L, 95%CI = 0.06; 1.6) and TCA (WMD = 0.51μmol/L; 95%CI = 0.18; 0.85) were both increased in serum sample; TCDCA (WMD = 2.64mmol/L, 95%CI = 0.16; 5.12) was rising, however GCDCA (WMD = -13.82mmol/L, 95%CI = -21.86; -5.78) was falling in bile sample of GSD patients. The level of serum DCA in the GSD patients was found to be increased by using chromatography, yet decreased by chromatography mass spectrometry.

CONCLUSION

The profiles of BAs demonstrated distinctive changes in GSD patients compared with healthy control subjects. Serum GCA, TCA and GCDCA, as the typically variant BAs, presented as a potential marker for earlier diagnosis of GSD, which could facilitate early prophylactic intervention. Yet, further validation of these biomarkers by longitudinal studies is still warranted in the future. PROSPERO registration number CRD42022339649.

Higher levels of systemic immune-inflammatory index are associated with the prevalence of gallstones in people under 50 years of age in the United States: a cross-sectional analysis based on NHANES

Introduction

Inflammation plays a significant role in gallstones formation. The prognosis of various illnesses was initially predicted using the systemic immune-inflammatory index (SII). We performed an updated analysis on the impact of SII and gallstones.

Methods

To investigate the connection between the SII and gallstones occurrence in a sample of individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020, we employed logistic regression analysis, subgroup analysis, and smoothing curve fitting.

Results

In our study, an aggregate of 4,950 individuals over the age of 20 were enrolled, and 429 of them claimed to have gallstones. A fully adjusted model showed that the third and fourth quartiles of SII was parallel associated with gallstones in adults (OR = 2.43, 95% CI = 1.39-4.26; OR = 2.97, 95% CI = 1.72-5.16) under 50 years. Subgroup analysis and smoothed curve fitting provided evidence in favor of this finding.

Conclusion

According to our research, gallstones are more likely to occur in US adults younger than 50 years.

Prevalence of metabolic associated fatty liver disease (MAFLD) in patients with gallstone disease. Study on a cohort of cases in South-Southeastern Mexico

INTRODUCTION

Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association.

AIMS

To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease.

MATERIALS AND METHODS

A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed.

VARIABLES ANALYZED

Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy.

STATISTICAL ANALYSIS

Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software.

RESULTS

A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection.

DISCUSSION AND CONCLUSIONS

The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Increasing gallstone disease prevalence and associations with gallbladder and biliary tract mortality in the US

BACKGROUND AND AIMS

We examined gallbladder and biliary tract mortality predictors in the US National Health and Nutrition Examination Survey (NHANES), 1988-1994, with 31 years of linked mortality data, and gallstone disease prevalence trends and associations in NHANES 2017-March 2020 prepandemic data.

APPROACH AND RESULTS

In NHANES 1988-1994, 18,794 participants were passively followed for mortality, identified by death certificate underlying or contributing causes, by linkage to the National Death Index through 2019. In NHANES 2017-March 2020, gallstone disease history was ascertained from 9232 adults. During NHANES 1988-2019 follow-up (median, 23.3 y), 8580 deaths occurred from all causes and 72 deaths with gallbladder or biliary tract disease. In multivariable-adjusted analysis, older age, male sex, prediabetes or diabetes, and physical inactivity were associated with gallbladder and biliary tract mortality, and non-Hispanic Black and Mexican American race-ethnicity were inversely associated. Between 1988-1994 and 2017-March 2020, gallstone disease prevalence increased from 7.4% to 13.9% and gallbladder surgery from 6.0% to 11.6%. In 2017-March 2020 in multivariable-adjusted analysis, female sex, diabetes, liver disease, proton pump inhibitors, abdominal pain, increased age, BMI, and liver stiffness were associated with gallstone disease, and non-Hispanic Black and non-Hispanic Asian race and alcohol were inversely associated.

CONCLUSIONS

In the US population, gallstone disease prevalence doubled over 3 decades, possibly because of the worsening of metabolic risk factors and growth of laparoscopic cholecystectomy. Gallbladder and biliary tract mortality and gallstone disease associations included factors such as prediabetes or diabetes, liver stiffness and proton pump inhibitors.

The Berberis vulgaris L. extract berberine exerts its anti-oxidant effects to ameliorate cholesterol overloading-induced cell apoptosis in the primary mice hepatocytes: an in vitro study

Cholesterol overloading stress damages normal cellular functions in hepatocytes and induces metabolic disorders to facilitate the development of multiple diseases, including cardiovascular diseases, which seriously degrades the life quality of human beings. Recent data suggest that the Berberis vulgaris L. extract berberine is capable of regulating cholesterol homeostasis, which is deemed as potential therapeutic drug for the treatment of cholesterol overloading-associated diseases, but its detailed functions and molecular mechanisms are still largely unknown. In the present study, we evidenced that berberine suppressed cell apoptosis in high-cholesterol-diet mice liver and cholesterol-overloaded mice hepatocytes. Also, cholesterol overloading promoted reactive oxygen species (ROS) generation to trigger oxidative damages in hepatocytes, which were reversed by co-treating cells with both berberine and the ROS scavenger N-acetylcysteine (NAC). Moreover, the underlying mechanisms were uncovered, and we validated that berberine downregulated Keap1, and upregulated Nrf2 to activate the anti-oxidant Nrf2/HO-1 signaling pathway in cholesterol overloading-treated hepatocytes, and both Keap1 upregulation and Nrf2 downregulation abrogated the suppressing effects of berberine on cell apoptosis in the hepatocytes with cholesterol exposure. Taken together, we concluded that berberine activated the anti-oxidant Keap1/Nrf2/HO-1 pathway to eliminate cholesterol overloading-induced oxidative stress and apoptotic cell death in mice hepatocytes, and those evidences hinted that berberine might be used as putative therapeutic drug for the treatment of cholesterol overloading-associated cardiovascular diseases.

Novel insights into the pathogenic impact of diabetes on the gastrointestinal tract

Type 2 and type 1 diabetes are common endocrine disorders with a progressively increasing incidence worldwide. These chronic, systemic diseases have multiorgan implications, and the whole gastrointestinal (GI) tract represents a frequent target in terms of symptom appearance and interdependent pathophysiological mechanisms. Metabolic alterations linked with diabetic complications, neuropathy and disrupted hormone homeostasis can lead to upper and/or lower GI symptoms in up to 75% of diabetic patients, with multifactorial involvement of the oesophagus, stomach, upper and lower intestine, and of the gallbladder. On the other hand, altered gastrointestinal motility and/or secretions are able to affect glucose and lipid homeostasis in the short and long term. Finally, diabetes has been linked with increased cancer risk at different levels of the GI tract. The presence of GI symptoms and a comprehensive assessment of GI function should be carefully considered in the management of diabetic patients to avoid further complications and to ameliorate the quality of life. Additionally, the presence of gastrointestinal dysfunction should be adequately managed to improve metabolic homeostasis, the efficacy of antidiabetic treatments and secondary prevention strategies.

Replacement of refined sugar by natural sweeteners: focus on potential health benefits

Refined sugar is a processed product containing 99% sucrose, which is obtained from sugarcane (70%) or sugar beet (30%). In modern societies, sugar continues to play a significant role in the diet, recognised not only for its flavour and special sweetening properties but also for its role in food preservation. On the other hand, a high consumption of refined sugar is associated with non-communicable diseases and many health issues such as a high risk of dental caries, overweight and neurodevelopmental disorders in children. Alternatives like unrefined sugars have generated a lot of interest as a healthy substitute due to their nutraceutical properties. This paper is aimed to review the beneficial effects of sugar derived from natural sources and highlight health problems that could be caused by refined processed sugar. Refined sugar is frequently used in variety of items including processed foods, soft drinks or ice creams although it is considered unhealthy due to its high salt and sugar content as well as added fats and artificial coloring. Natural sugars are preferred because they have a high nutritional value and a high concentration of healthy compounds, which offset the negative effects of refined sugar. Therefore, removing refined sugar or at least reducing its consumption should be promoted as a healthier option in food choices.

The Potential of the Mediterranean Diet to Improve Mitochondrial Function in Experimental Models of Obesity and Metabolic Syndrome

The abnormal expansion of body fat paves the way for several metabolic abnormalities including overweight, obesity, and diabetes, which ultimately cluster under the umbrella of metabolic syndrome (MetS). Patients with MetS are at an increased risk of cardiovascular disease, morbidity, and mortality. The coexistence of distinct metabolic abnormalities is associated with the release of pro-inflammatory adipocytokines, as components of low-to-medium grade systemic inflammation and increased oxidative stress. Adopting healthy lifestyles, by using appropriate dietary regimens, contributes to the prevention and treatment of MetS. Metabolic abnormalities can influence the function and energetic capacity of mitochondria, as observed in many obesity-related cardio-metabolic disorders. There are preclinical studies both in cellular and animal models, as well as clinical studies, dealing with distinct nutrients of the Mediterranean diet (MD) and dysfunctional mitochondria in obesity and MetS. The term "Mitochondria nutrients" has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity. Such effects are valuable to counteract the mitochondrial dysfunction associated with obesity-related abnormalities and can represent the beneficial feature of polyphenols-enriched olive oil, vegetables, nuts, fish, and plant-based foods, as the main components of the MD. Thus, developing mitochondria-targeting nutrients and natural agents for MetS treatment and/or prevention is a logical strategy to decrease the burden of disease and medications at a later stage. In this comprehensive review, we discuss the effects of the MD and its bioactive components on improving mitochondrial structure and activity.

The Mitochondrial tRNAPhe 625G>A Mutation in Three Han Chinese Families With Cholecystolithiasis

In this study, we assessed three Chinese families with inherited cholecystolithiasis and conducted the clinical, genetic, and molecular characterization of these subjects. Eight of eighteen matrilineal relatives had a clinical phenotype in these three families. Sequence analysis of complete mitochondrial genomes in these probands identified the homoplasmic tRNA^Phe 625 G > A mutation and distinct sets of mtDNA polymorphisms belonging to haplogroups H2, F4b, and M10a. The 625G > A mutation disturbed the classic G-C base-pairings at a highly conserved position 49 in the T-stem of mitochondrial tRNAs. Molecular dynamics simulation showed that the structure of tRNA^phe with 625 G > A mutation was noticeably remodeled while compared with the isoform of the wild type. The occurrence of tRNA^Phe 625 G > A mutation in these various genetically unrelated subjects strongly indicates that this mutation is involved in the pathogenesis of cholecystolithiasis. This is the first evidence that tRNA mutations are associated with cholecystolithiasis, and it provided more insights into the genetic mechanism of cholecystolithiasis.

Insights into modifiable risk factors of cholelithiasis: A Mendelian randomization study

BACKGROUND AND AIMS

The risk factors of cholelithiasis have not been clearly identified, especially for total cholesterol. Here, we try to identify these causal risk factors.

APPROACH AND RESULTS

We obtained genetic variants associated with the exposures at the genome-wide significance (p < 5 × 10^-8 ) level from corresponding genome-wide association studies. Summary-level statistical data for cholelithiasis were obtained from FinnGen and UK Biobank (UKB) consortia. Both univariable and multivariable Mendelian randomization (MR) analyses were conducted to identify causal risk factors of cholelithiasis. Results from FinnGen and UKB were combined using the fixed-effect model. In FinnGen, the odds of cholelithiasis increased per 1-SD increase of body mass index (BMI) (OR = 1.631, p = 2.16 × 10^-7 ), together with body fat percentage (OR = 2.108, p = 4.56 × 10^-3 ) and fasting insulin (OR = 2.340, p = 9.09 × 10^-3 ). The odds of cholelithiasis would also increase with lowering of total cholesterol (OR = 0.789, p = 8.34 × 10^-5 ) and low-density lipoprotein-cholesterol (LDL-C) (OR = 0.792, p = 2.45 × 10^-4 ). However, LDL-C was not significant in multivariable MR. In UKB, the results of BMI, body fat percentage, total cholesterol, and LDL-C were replicated. In meta-analysis, the liability to type 2 diabetes mellitus and smoking could also increase the risk of cholelithiasis. Moreover, there were no associations with other predominant risk factors.

CONCLUSIONS

Our MR study corroborated the risk factors of cholelithiasis from previous MR studies. Furthermore, lower total cholesterol level could be an independent risk factor.

Oxidative Stress and Free Radical Processes in Tumor and Non-Tumor Obstructive Jaundice: Influence of Disease Duration, Severity and Surgical Treatment on Outcomes

The aim of this study was to assess the patterns and pattern disruptions of free radical processes in patients with obstructive jaundice of various origins, and the severity of jaundice before and after decompression. Oxidative stress markers were determined in 128 patients with obstructive jaundice with a tumor genesis (23.4%) or non-tumor genesis (76.6%). The patients were hospitalized at different stages of clinical signs of jaundice. We studied the anti-peroxide activity in plasma, basal and stimulated indicators of the chemiluminescence intensity in leukocytes, leukocyte activity coefficients reflecting the level of reactive oxygen species generated by leukocytes, malondialdehyde levels indicative of the degree of lipid peroxidation and cellular destruction, liver enzymes (markers of cytolysis) and bilirubin levels. Data for hepatocyte death and markers of oxidative stress correlated with the severity of jaundice, its duration and the method of its surgical correction. It is proposed that using markers of free radical processes to assess the prognosis and effectiveness of treatment and to personalize treatment measures will improve the results of jaundice treatment.

Astragalus Polysaccharides Ameliorate Diet-Induced Gallstone Formation by Modulating Synthesis of Bile Acids and the Gut Microbiota

Cholesterol gallstone (CG) disease has relationships with several metabolic abnormalities. Astragalus polysaccharides (APS) have been shown to have multiple benefits against metabolic disorders. We attempted to uncover the effect and mechanism of action of APS on diet-induced CG formation in mice. Animals were fed a chow diet or lithogenic diet (LD) with or without APS supplementation. The effect of APS on CG formation was evaluated. The level of individual bile acids (BAs) in gallbladder bile and ileum were measured by liquid chromatography-tandem mass spectrometry. Real-time reverse transcription-quantitative polymerase chain reaction and western blotting were used to assess expression of the genes involved in BA metabolism and the enterohepatic circulation. Cecal contents were collected to characterize microbiota profiles. APS ameliorated LD-induced CG formation in mice. APS reduced the level of total cholesterol, bile acid hydrophobicity index and cholesterol saturation index in gallbladder bile. The protective effect of APS might result from reduced absorption of cholic acid in the intestine and increased hepatic BA synthesis. APS relieved the LD-induced activation of the intestinal farnesoid X receptor and decreased ileal expression of fibroblast growth factor 15. In the liver, expression of cytochrome P450 (Cyp) enzyme Cyp7a1 and Cyp7b1 was increased, whereas expression of adenosine triphosphate-binding cassette (Abc) transporters Abcg5 and Abcg8 was decreased by APS. APS improved the diversity of the gut microbiota and increased the relative abundance of the Bacteroidetes phylum. APS had demonstratable benefits against CG disease, which might be associated with enhanced BA synthesis and improved gut microbiota. Our results suggest that APS may be a potential strategy for the prevention of CG disease.

Hepatocrinology

Hepatocrinology is defined as a bidirectional, complex relationship between hepatic physiology and endocrine function, hepatic disease and endocrine dysfunction, hepatotropic drugs and endocrine function, and endocrine drugs and hepatic health. The scope of hepatocrinology includes conditions of varied etiology (metabolic, infectious, autoimmune, and invasive) that we term as hepato-endocrine syndromes. This perspective shares the definition, concept, and scope of hepatocrinology and shares insight related to this aspect of medicine. It is hoped that this communication will encourage further attention and research in this critical field.

Association of apolipoprotein B XbaI (rs693) polymorphism and gallstone disease risk based on a comprehensive analysis

BACKGROUND

Our aim was to investigate the association between XbaI gene polymorphisms in the apolipoprotein B (APOB) gene and gallstone disease (GD) risk through a comparison of the allele and genotype distribution frequencies at this site using meta-analysis.

METHODS

A literature search was performed using PubMed and Wanfang through Jun 1, 2020. Odds ratios (ORs) and 95 % confidence intervals (CIs) were used to assess the strength of associations.

RESULTS

After a comprehensive search, 14 different articles that met the inclusion criteria were selected, with 1583 cases and 1794 controls. Individuals carrying the A-allele or AA genotype of the rs693 polymorphism were determined to possibly have an increased risk of GD. For example, there was a significant relationship between the rs693 polymorphism and increased GD risk in the whole group (OR: 1.40, 95 % CI: 1.05-1.87 in the allelic contrast model), the Asian population (OR: 1.58, 95 % CI: 1.48-2.84 in the heterozygote model), and the hospital-based source of the control (OR: 1.79, 95 % CI: 1.13-2.84 in the dominant model).

CONCLUSIONS

This study suggests that the APOB rs693 polymorphism is potentially associated with GD susceptibility, which might offer a detection marker for use in future large scale clinic research.

Gut Microbiome in a Russian Cohort of Pre- and Post-Cholecystectomy Female Patients

The last decade saw extensive studies of the human gut microbiome and its relationship to specific diseases, including gallstone disease (GSD). The information about the gut microbiome in GSD-afflicted Russian patients is scarce, despite the increasing GSD incidence worldwide. Although the gut microbiota was described in some GSD cohorts, little is known regarding the gut microbiome before and after cholecystectomy (CCE). By using Illumina MiSeq sequencing of 16S rRNA gene amplicons, we inventoried the fecal bacteriobiome composition and structure in GSD-afflicted females, seeking to reveal associations with age, BMI and some blood biochemistry. Overall, 11 bacterial phyla were identified, containing 916 operational taxonomic units (OTUs). The fecal bacteriobiome was dominated by Firmicutes (66% relative abundance), followed by Bacteroidetes (19%), Actinobacteria (8%) and Proteobacteria (4%) phyla. Most (97%) of the OTUs were minor or rare species with ≤1% relative abundance. Prevotella and Enterocossus were linked to blood bilirubin. Some taxa had differential pre- and post-CCE abundance, despite the very short time (1–3 days) elapsed after CCE. The detailed description of the bacteriobiome in pre-CCE female patients suggests bacterial foci for further research to elucidate the gut microbiota and GSD relationship and has potentially important biological and medical implications regarding gut bacteria involvement in the increased GSD incidence rate in females.

Physical Activity Modulating Lipid Metabolism in Gallbladder Diseases

Physical activity encompasses a series of overall benefits on cardiovascular health and metabolic disorders. Research has recently focused on the hepatobiliary tract, as an additional target of the health-related outcomes of different types of physical exercise. Here, we focus on the global features of physical activity with respect to exercise modality and intensity, and on studies linking physical activity to lipid metabolism, gallbladder diseases (gallstones, symptoms, complications and health-related quality of life), gallbladder motor-function, enterohepatic circulation of bile acids, and systemic metabolic inflammation. Additional studies need to unravel the pathophysiological mechanisms involved in both beneficial and harmful effects of physical activity in populations with different metabolic conditions.

Experience of using ursodeoxycholic acid to dissolve gallstones

Objective of the study. A 5-year prospective study was aimed to evaluate the efficacy of Ursosan treatment for dissolving gallstones.

Material and methods. Patients who had single gallbladder stones were randomized to group A, in which 47 people completed the study (16 men and 31 women, median age is 67.6 years), and group B – 41 people 14 men and 27 women, median age is 68, 1 years). All patients of group A continuously received continuous treatment with ursodeoxycholic acid drug Ursosan at a dose of 10 mg /kg per day for 5 years. The patients of group D did not receive Ursosan; these individuals received periodic courses of spasmodic drugs. The patients passed clinical examination, laboratory tests, transabdominal ultrasound of the liver and biliary tract before the study, 2 times a year for 5 years and after the study.

Results. After 5 years of treatment, stones were detected in 10.6% of patients in group A. In group B, the incidence of gallstones did not change after 5 years of treatment, that is, calculi were detected in all patients (p <0.001). At the end of the study, no muldoi tiple stones were observed in any of the patients of group A, while multiple stones were detected in 2/3 of group B patients after 5 years of treatment. A distinct decrease in pain syndrome frequency and improvement in contractile function of the gallbladder were recorded in patients of group A as compared to the patients of group B by the end of the observation period. The side effect profile did not differ in groups A and B. The study showed good tolerance of Ursosan for 5 years of continuous administration of the drug.

Findings. The 5-year prospective study showed that Ursosan’s efficacy in dissolving gallstones accounted for 90%. Ursosan also prevented the formation of new calculi and reduced the frequency of pain, improved the gall-bladder contractile function and reduced the need for cholecystectomy by the end of the observation period.

Association of suboptimal health status with intestinal microbiota in Chinese youths

Suboptimal health status (SHS), a physical state between health and disease, is a subclinical and reversible stage of chronic disease. Previous studies have shown alterations in the intestinal microbiota in patients with some chronic diseases. This study aimed to investigate the association between SHS and intestinal microbiota in a case-control study with 50 SHS individuals and 50 matched healthy controls. Intestinal microbiota was analysed by MiSeq 250PE. Alpha diversity of intestinal microbiota in SHS individuals was higher compared with that of healthy controls (Simpson index, W = 2238, P = .048). Beta diversity was different between SHS and healthy controls (P = .018). At the phylum level, the relative abundance of Verrucomicrobia was higher in the SHS group than that in the controls (W = 2201, P = .049). Compared with that of the control group, nine genera were significantly higher and five genera were lower in abundance in the SHS group (all P < .05). The intestinal microbiota, analysed by a random forest model, was able to distinguish individuals with SHS from the controls, with an area under the curve of 0.79 (95% confidence interval: 0.77-0.81). We demonstrated that the alteration of intestinal microbiota occurs with SHS, an early stage of disease, which might shed light on the importance of intestinal microbiota in the primary prevention of noncommunicable chronic diseases.