Blood lipid metabolism and the risk of gallstone disease: a multi-center study and meta-analysis

Gut microbiota promotes cholesterol gallstone formation through the gut-metabolism-gene axis

BACKGROUND

Gallstone disease, arising from the interplay between host metabolism and gut microbiota, represents a significant health concern. Dysbiosis of the gut microbiome and disruptions in circadian rhythm contribute to the pathogenesis of gallstones. This study conducted a comprehensive analysis of gut microbiota and metabolites derived from stool and serum samples of 28 patients with cholesterol gallstones (CGS) and 19 healthy controls, employing methodologies such as 16S rRNA sequencing, metaproteomics, metabolomics, and host genetic analysis. Additionally, a retrospective cohort study was utilized to assess the efficacy of probiotics or ursodeoxycholic acid (UDCA) in preventing CGS formation post-bariatric surgery.

RESULTS

In CGS patients, gut microbiota diversity shifted, with harmful bacteria rising and beneficial ones declining. The altered microbiota primarily affected amino acid, lipid, nucleotide, and carbohydrate metabolism. Metabolic abnormalities were noted in amino acids, glucose, lipids, and bile acids with decreased levels of ursodeoxycholic, glycosodeoxycholic, and glycolithocholic acids, and increased glycohyodeoxycholic and allocholic acids. Glutamine and alanine levels dropped, while phenylalanine and tyrosine rosed. Animal studies confirmed gene changes in gallbladder tissues related to bile acid, energy, glucose, and lipid metabolism. Importantly, UDCA and probiotics effectively reduced CGS risk post-bariatric surgery, especially when combined.

CONCLUSIONS

Multi-omics can clarify CGS pathology, by focusing on the gut-metabolism-gene axis, paving the way for future studies on CGS prevention and treatment through gut microbiota or metabolic interventions.

Association of cardiometabolic index with gallstone disease and insulin resistance based on NHANES data

BACKGROUND

Cardiometabolic index (CMI) is an index integrating visceral obesity and dyslipidemia. This study intends to scrutinize the connection between CMI and gallstone disease (GSD) and to elucidate the association between CMI and insulin resistance (IR) in patients with GSD.

METHODS

To explore the potential nonlinear association and determine the inflection point, a restricted cubic spline (RCS) analysis was performed. Following categorization of CMI based on the identified inflection point, multivariate logistic regression models, subgroup analyses, and interaction tests were utilized to assess the connection between CMI and GSD, as well as between CMI and IR in GSD patients. The homeostasis model assessment for IR (HOMA-IR) and triglyceride-glucose (TyG) index was applied to evaluate IR. Spearman analysis was implemented to investigate the connection between CMI and HOMA-IR. The predictive performance of each indicator was evaluated by the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

RESULTS

The study included 2311 individuals, with a GSD prevalence of 10.90%. RCS analysis revealed a nonlinear positive correlation between CMI and GSD (nonlinear P < 0.001), as well as between CMI and IR (nonlinear P < 0.001). In the fully adjusted multivariable logistic regression analysis of covariates, compared with the low-category CMI group, the high-category CMI was significantly associated with the risk of GSD (OR = 1.547, 95% CI: 1.143-2.092, P = 0.005), IR (OR = 4.990, 95% CI: 2.517-9.892, P < 0.001). Subgroup analysis demonstrated that the correlation between CMI and GSD was stronger in females. Spearman correlation analysis showed a positive association between CMI and HOMA-IR in GSD patients (r = 0.548, P < 0.001). The ROC curve demonstrated the predictive performance of the CMI model for GSD (AUC = 0.743), which was superior to conventional indicators such as Body Mass Index and Waist Circumference; the predictive performance of CMI (AUC = 0.772) for IR was consistent with that of TyG (AUC = 0.772).

CONCLUSION

Our research demonstrates that CMI exhibits a nonlinear positive correlation with the incidence of GSD and IR. This suggests that CMI may serve as a novel and valuable indicator for further investigating the intricate relationships among metabolic syndrome, obesity, and GSD.

Association between platelet-to-high-density lipoprotein cholesterol ratio and gallstone prevalence in the American adult population: a cross-sectional study analysis

OBJECTIVE

The platelet-to-high-density lipoprotein cholesterol ratio(PHR), a novel marker of inflammatory response and metabolic dysregulation, has been linked to various chronic conditions.This study aimed to evaluate the association between PHR and the prevalence of gallstones.

METHODS

This cross-sectional study analyzed data collected from the United States National Health and Nutrition Examination Survey(NHANES)between 2017 and 2023. Multivariate logistic regression, generalized additive models, and subgroup analyses were employed to assess the relationship between PHR and gallstone prevalence.

RESULTS

A total of 13,163 participants were included, of whom 1,441(10.95%) self-reported a history of gallstones. After adjusting for potential confounders, a positive association was observed between the natural log-transformed PHR(LN[PHR])and gallstone prevalence(OR = 1.27, 95%CI: 1.09-1.49). This positive correlation became more pronounced with increasing PHR levels(P-trend = 0.01). Smooth curve fitting analysis indicated a linear relationship between PHR and gallstone prevalence. Subgroup analyses revealed that the association was strongest in participants aged 20-39 years, women, and individuals of other racial/ethnic groups.

CONCLUSION

Elevated PHR levels are significantly associated with a higher risk of gallstones. While our observational data suggest plausibility for PHR-gallstone, these findings should be interpreted as hypothesis-generating rather than definitive clinical evidence. Future mechanistic studies should elucidate whether this association reflects causal pathways or epiphenomenal relationships.

Antimicrobial action and mechanism of piscidin against Helicobacter pylori

BACKGROUND

The rise of antibiotic-resistant Helicobacter pylori (Hp) strains is complicating the management of common gastrointestinal conditions such as gastritis and ulcers. In search of effective treatment options, antimicrobial peptides are being explored as a promising strategy.

METHODS

Leveraging bioinformatics, we dissected structural and sequence profiles of piscidin, an antimicrobial peptide. We investigated whether long-term piscidin exposure induces resistance in Hp strains by measuring their minimum inhibitory concentration. The Oxford cup test was applied to measure inhibition zones of piscidin against Hp strains. Following piscidin treatment, we monitored morphological alterations in Hp strains using scanning electron microscopy, and changes in urease activity, expressions of virulence factors CagA and UreB, and adenosine triphosphate levels. Cytotoxicity of piscidin was evaluated in AGS and 293T cells.

RESULTS

Piscidin inhibited proliferation of Hp strains, with a low propensity of inducing resistance. Delving into underlying mechanisms, we observed piscidin could alter morphology of Hp strains, suppress urease activity, and downregulate expressions of virulence factors CagA and UreB, while also reducing intracellular ATP levels. Piscidin had good security.

CONCLUSION

Piscidin is a potent antibacterial agent against Hp with low resistance risk, making it a safe and effective treatment candidate.

Predictive role of insulin resistance surrogates in gallstone disease

Several studies have confirmed the association between insulin resistance (IR) surrogates and the risk of cardiovascular disease. This study aimed to investigate the correlation between 4 IR surrogates: triglyceride-glucose index (TyG), triglyceride-glucose index with waist circumference (TyG-WC), triglyceride-glucose index with body mass index (TyG-BMI), and triglycerides/high-density lipoprotein cholesterol ratio, and the risk of gallstone disease. This retrospective cross-sectional study involved a total of 19,696 participants who were divided into gallstone and non-gallstone groups based on ultrasound findings. Biochemical parameters and ultrasound results were collected and statistically analyzed. Nonparametric U test, Chi-square test, and subgroup analysis were used to examine the differences in expression of the 4 IR surrogates between the 2 groups. Logistic regression models and receiver operating characteristic curves were employed to evaluate the relationships and predictive ability of the 4 surrogates for gallstone disease. The levels of the 4 surrogates of IR were significantly higher in individuals with gallstone disease (GSD) compared to those without GSD (P < .001). After adjusting for age, gender, and personal medical history, TyG-WC and TyG-BMI emerged as significant predictors of gallstones in both genders. The predictive ability of these IR surrogates was stronger for gallstone disease in females than in males. In females, the area under the curve for TyG-WC and TyG-BMI were 0.683 and 0.629, respectively, while for males, these values were 0.544 and 0.528. When age was included with TyG-WC and TyG-BMI to predict GSD, the area under the curve values increased to 0.734 and 0.733 for females, and 0.684 and 0.682 for males. The study found that TyG-WC and TyG-BMI were identified as independent risk factors for the prevalence of GSD. Additionally, combined with age, TyG-WC and TyG-BMI showed good predictive value for the prevalence of GSD in females.

Cardiometabolic index as a predictor of gallstone risk: evidence from NHANES 2017-2020

BACKGROUND

The Cardiometabolic Index (CMI), a composite marker integrating lipid profiles (triglycerides-to-HDL-C ratio) and abdominal obesity (waist-to-height ratio), we aimed to assess its association with gallstone prevalence.

METHODS

We analyzed data from 2,692 participants in the NHANES 2017-2020 dataset. Gallstones were identified through self-reported data, which may introduce bias in the diagnosis. This limitation should be considered when interpreting the results. Logistic regression modelling, smoothed curve fitting and threshold effect analysis assessed the association between CMI and gallstones.

RESULT

Higher CMI was significantly associated with an increased risk of gallstones (OR = 1.90, 95% CI: 1.37-2.62, P < 0.0001). A threshold effect was observed at CMI = 0.85, below which risk increased significantly (OR = 2.62, 95% CI:1.34-5.12, P = 0.0049), but became non-significant above this value. The association was stronger in women.

CONCLUSION

Our findings support the use of CMI as a potential predictive marker for gallstone risk, suggesting its integration into clinical assessments for early detection and prevention.

Metabolic abnormalities, liver enzymes increased risk of gallstones: a cross-sectional study and multivariate mendelian randomization analysis

BACKGROUND AND AIMS

Some studies have explored the relationship between metabolic abnormalities, elevated liver enzymes and gallstone risk, but the results have been inconsistent. The aim of this study was to comprehensively assess the relationship between metabolic abnormalities, liver enzymes, and gallstone risk through a cross-sectional study and Mendelian randomization analysis.

METHODS

Firstly, a cross-sectional study was conducted involving 555,31 subjects who underwent physical examinations at the Second Affiliated Hospital of Xi'an Jiaotong University between January 2021 and December 2021. The diagnosis of gallstones was based on ultrasound findings. Multivariable logistic regression analysis was employed to investigate the associations between metabolic abnormalities, liver enzymes, and the risk of gallstones. Additionally, two-sample and multivariate Mendelian randomization analyses were performed to further explore the genetic causal associations.

RESULTS

In the cross-sectional analysis, the detection rate of gallstones was 4.8%, showing a gradual increase with age and BMI (body mass index) in both men and women. Gallstones were found to be comorbid with various metabolic disorders and were associated with elevated liver enzymes. Multivariate analysis showed that female sex, age, body mass index, diastolic blood pressure, fatty liver, alanine aminotransferase, and gamma-glutamyltransferase may be independent risk factors for gallstones, whereas high-density lipoprotein cholesterol may be a protective factor. Two-sample and multivariate Mendelian randomization analyses further revealed a causal association between genetically predicted BMI, type 2 diabetes mellitus, alanine aminotransferase, gamma-glutamyl transferase, and an increased risk of gallstones.

CONCLUSION

The findings suggest that metabolic abnormalities and elevated liver enzymes may increase the risk of developing gallstones.

Gallstones in the Era of Metabolic Syndrome: Pathophysiology, Risk Prediction, and Management

Gallstone disease (GSD) and metabolic syndrome (MetS) are increasingly prevalent conditions with significant global health implications. Recent evidence highlights a strong epidemiological association between these disorders, driven by shared pathophysiological mechanisms. This review provides a comprehensive analysis of the intricate relationship between MetS and GSD, focusing on the role of insulin resistance, dyslipidemia, obesity, and gut microbiota dysbiosis in gallstone formation. An integrated pathophysiological model is proposed, linking metabolic disturbances to bile cholesterol supersaturation, gallbladder dysmotility, and chronic inflammation. The review also explores clinical implications, including risk prediction models based on metabolic parameters, early detection biomarkers, and targeted interventions such as lifestyle modifications, pharmacological therapies, and microbiome modulation. By addressing the metabolic underpinnings of GSD, this synthesis offers a foundation for developing preventive and therapeutic strategies to mitigate the burden of these interconnected conditions. Future research directions are outlined to refine mechanistic insights and improve clinical outcomes.

Sodium butyrate activates peroxisome proliferator-activated receptor γ to suppress lithogenic diet-induced cholesterol gallstones in mice

Peroxisome proliferator-activated receptor γ (PPAR-γ) is crucial in forming cholesterol stones. Sodium butyrate (NaB), a short-chain fatty acid, shows potential for gallstone treatment by activating PPAR-γ. This study aimed to elucidate the effects of NaB on cholesterol gallstones in mice fed a lithogenic diet (LD). Ezetimibe (5 mg/day) was used as a positive control, and a PPAR-γ antagonist (CW9661, 4 mg/kg/day) was used to investigate PPAR-γ. Body weight, gallstone incidence, lipid concentrations in blood, bile, and liver, liver function evaluation, histological analysis, and cholesterol metabolism-related gene expression were evaluated. NaB and ezetimibe suppressed gallstone formation, serum AST, ALT, and ALP levels, and serum/liver TG and TC. They also reduced bile cholesterol and phospholipids, and liver histological damage. NaB activated PPAR-γ, CYP7A1, ABCA1, and ABCB11 while suppressing ABCG5/G8 gene expression. CW9661 reversed NaB's benefits in LD mice. This study provides scientific evidence that NaB activated PPAR-γ to improve gallstones.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-024-01721-x.

Role of Helicobacter pylori infection and the risk of cholelithiasis

This article aims to deepen the understanding of the role of Helicobacter pylori (H. pylori) infection in the development of cholelithiasis, initiated by the article by Yao et al, who investigated the potential link between H. pylori infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants. They also performed a comprehensive analysis of previously published studies on H. pylori and cholelithiasis, finding a positive association therein [odds ratio (OR) = 1.103, P = 0.049]. Patients positive for H. pylori also had lower levels of total and direct bilirubin, but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients (P < 0.05). Cohort studies have confirmed that H. pylori is a risk factor for cholelithiasis (P < 0.0001), and aggregate analyses of case-control and cross-sectional studies have shown a positive association between H. pylori and cholelithiasis in Asia (OR = 1.599, P = 0.034), but not in Europe (OR = 1.277, P = 0.246). Moreover, H. pylori appears to be related to a higher ratio of choledocholithiasis/cholecystolithiasis (OR = 3.321, P = 0.033). The authors conclude that H. pylori infection is positively correlated with cholelithiasis, particularly with the choledocholithiasis phenotype, especially in Asia, and it is potentially related to bilirubin and cholesterol metabolism.

The association between life's essential 8 and gallstones: A cross-sectional study

This study investigates the relationship between Life's Essential 8 (LE8), a measure of cardiovascular health (CVH), and the risk of gallstones in adult Americans. We analyzed data from 5,024 participants aged 20 and older, using information from the 2017-2020 National Health and Nutrition Examination Survey. Gallstone presence was determined via a standard questionnaire. LE8 scores, representing four health behaviors (sleep, tobacco/nicotine exposure, physical activity, and diet) and four health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure), were categorized into low, moderate, and high CVH groups. Weighted logistic regression, restricted cubic splines (RCS), and stratified analyses were used to assess the association between LE8 and gallstones. Of the 5,024 participants, 543 (11.22%) had gallstones. In fully adjusted models, participants with high CVH (LE8 ≥ 80) had a 59% lower risk of gallstones compared to those with low CVH (LE8 < 50) (OR: 0.41, 95% CI: 0.23-0.72, P = 0.010). RCS analyses suggested a nonlinear relationship between LE8 and gallstones. Stratified analysis showed a stronger association in participants under 65 (OR: 0.26, 95% CI: 0.15-0.44), females (OR: 0.44, 95% CI: 0.24-0.81), those with higher education (OR: 0.39, 95% CI: 0.19-0.78), non-white individuals (OR: 0.28, 95% CI: 0.13-0.60), and married participants (OR: 0.40, 95% CI: 0.20-0.80).Higher CVH, as measured by LE8, is associated with a lower risk of gallstones among adult Americans.

Correlation between gallstones and fasting blood glucose to serum high-density lipoprotein cholesterol ratio among American adults

Background

Research indicates that the ratio of fasting blood glucose (FBG) to serum high-density lipoprotein cholesterol (HDL-C) (GHR) can accurately predict many diseases. Nevertheless, the relationship between GHR and the risk of gallbladder stones remains unclear. This study investigates the possible relationship between GHR and the incidence of gallbladder stones.

Methods

This research used information gathered from the National Health and Nutrition Examination Survey (NHANES) between March 2017 and March 2020. A calculation was made to determine the GHR by dividing the fasting blood glucose level by the HDL-C level. Several statistical methods, including analysis of threshold effects, smoothed curve fitting, multiple logistic regression modeling, and subgroup analysis, were utilized to investigate the connection between GHR and gallstones.

Results

In 3898 U.S. adults, GHR was significantly positively associated with the prevalence of gallbladder stones. In a fully adjusted model, the incidence of gallbladder stones increased by 7% with each 1-unit increase in GHR (OR [95% Cl] = 1.07 [1.02, 1.14]). Compared with members in the low group, those in the high group had a 100% higher likelihood of getting gallbladder stones (OR [95% CI] = 2.00 [1.31, 3.04]), and this stabilizing connection was always present in the different subgroups. With the help of smooth curve fitting, the research also showed that there was a connection that was formed like an upside-down L shape between GHR and gallbladder stones. The analysis of the threshold effect revealed that the inflection point was 4.28.

Conclusion

The results revealed an inverted L-shaped connection between GHR and gallbladder stones. Keeping GHR levels within a certain range is associated with a lower incidence of gallstones in the general population.

Cardiometabolic index as a predictor of gallstone incidence in U.S. adults: insights from NHANES 2017-2020

BACKGROUND

Gallstone disease (GSD) is associated with obesity. The Cardiometabolic Index (CMI), a metric that accurately assesses central adiposity and visceral fat, has not been extensively studied in relation to GSD risk. This study investigates the link between CMI and GSD incidence in U.S. adults.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey(NHANES)(2017-2020) to assess the association between CMI and GSD, adjusting for confounders such as age, sex, race, chronic diseases, and lifestyle factors. Multivariable logistic regression models and subgroup analyses were employed. Generalized Additive Models (GAM) and advanced curve fitting techniques were used to explore potential non-linear relationships, with threshold effects determined via piecewise linear regression if such relationships were identified. Receiver Operating Characteristic (ROC) curves evaluated and compared the predictive performance of CMI, Body Mass Index (BMI), and Waist Circumference (WC), establishing optimal cutoff values along with their sensitivity and specificity.

RESULTS

This study included 3,706 participants, of whom 10.6% (392) had GSD. Participants with GSD showed significantly higher CMI values (0.57 vs. 0.44, P = 0.0002). The GSD group included more females and older adults, with increased risks for hypertension, diabetes, higher serum cholesterol and creatinine levels, and a higher risk of cancer. Logistic regression analysis revealed that higher CMI was significantly associated with greater GSD incidence (OR = 1.19, 95% CI = 1.02-1.38, P < 0.0001). The ROC curve demonstrated superior predictive performance (AUC = 0.778), outperforming conventional metrics like BMI and WC. GAM analysis indicated a non-linear positive correlation between CMI and GSD, with an optimal threshold of 0.996. Subgroup analysis found the strongest association among females, individuals aged 20-39, non-Hispanic Whites, those without a history of coronary heart disease, and alcohol consumers.

CONCLUSION

Our study reveals a nonlinear positive correlation between the CMI and the incidence of GSD among U.S. adults, with a threshold value of 0.996. Despite limitations in sample size that constrained the analysis of a fully adjusted model, after adjusting for confounding factors, the AUC for predicting GSD using CMI reached 0.778, surpassing traditional metrics. These findings underscore the importance of CMI as a critical risk factor and emphasize the necessity of targeted interventions for high-risk populations.

Kidney and gallbladder stones and the risk of prostate cancer: Results from the EPICAP study

BACKGROUND

Prostate cancer remains the most frequent cancer among men, representing a significant health burden. Despite its high morbidity and mortality rates, the etiology of prostate cancer remains relatively unknown, with only non-modifiable established risk factors. Chronic inflammation has emerged as a potential factor in prostate carcinogenesis. We investigated the role of kidney and gallbladder stones and the risk of prostate cancer.

METHODS

We used data from EPICAP, a population-based case-control study. A total of 819 diagnosed prostate cancer cases and 879 controls were face-to-face interviewed using a standardized questionnaire that collected information on personal medical history, including history of kidney and gallbladder stones. Odds Ratios (OR) and their 95% confidence interval (CI) were estimated using multivariate unconditional logistic regression.

RESULTS

Our study revealed intriguing patterns regarding kidney and gallbladder stones in relation to prostate cancer risk. The analysis indicated significant potential associations between kidney stones and the risk of prostate cancer (OR: 1.46 95% CI: 1.13-1.90), particularly in men with a history of kidney infection. Additionally, our data suggested a possible relationship between gallbladder stones and prostate cancer when considering triglyceride (OR: 2.27, 95% CI: 0.99-5.28), although further research is needed for a conclusive understanding.

CONCLUSIONS

Our results suggest an association between calculi and the risk of prostate cancer. Findings from this study underscore the need for a more comprehensive investigation to understand the role of chronic inflammation or metabolism and delineate the mechanisms underlying these potential associations in order to guide the development of targeted preventive strategies for aggressive prostate cancer.

Age-period-cohort analysis of gallbladder and biliary diseases epidemiological trends from 1990 to 2021 and forecasts for 2035: a systematic analysis from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary diseases (GABD) represent prevalent disorders of the digestive system.

METHODS

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were extracted from the Global Burden of Disease (GBD) 2021 study. The estimated annual percentage change (EAPC) was utilized to quantify temporal trends in GABD. Age-period-cohort analysis was conducted to determine the effects attributable to age, period, and birth cohort. Additionally, we projected global trends to 2035.

RESULTS

Globally, GABD incident cases, mortality cases, and DALYs increased by 60.11%, 71.71%, and 56.90%, respectively. However, all corresponding age-standardized rates (ASRs) demonstrated overall downward trends with estimated annual percentage changes (EAPC) of -0.32 (-0.38 to -0.26), -0.95 (-1.08 to -0.83), and - 0.69 (-0.74 to -0.65), respectively. The number of incident cases was higher in females than in males across all age groups. The age effect indicated that older individuals had higher age-specific incidence and death rates. Both period and cohort effects showed declining risk across incidence and mortality. The ASIR and ASMR of GABD are projected to continue decreasing over the next 15 years.

CONCLUSION

GABD continue to pose a significant global public health challenge, particularly affecting women and the elderly population. Consequently, the implementation of effective interventions to mitigate the GABD burden is of paramount importance.

Exploring the causal impact of body mass index on metabolic biomarkers and cholelithiasis risk: a Mendelian randomization analysis

Obesity is a well-established risk factor for various diseases, but the mechanisms through which it influences disease development remain unclear. Using Mendelian randomization (MR) analysis, we examined the causal relationship between BMI, 249 metabolic traits, and cholelithiasis. BMI data were obtained from four sources, and cholelithiasis data were from two distinct datasets. We analyzed the direct effect of BMI on cholelithiasis and identified key metabolic mediators. BMI was found to be positively associated with the risk of cholelithiasis across all datasets analyzed. A total of 176 metabolites were identified to be significantly associated with BMI, including amino acids, cholesterol esters, free cholesterol, triglycerides, and phospholipids. Among these, 49 metabolites were identified as mediators in the BMI-cholelithiasis relationship. Specifically, fatty acid levels, cholesteryl esters, phospholipids, triglycerides, and free cholesterol were key mediators in this relationship, with mediation proportions ranging from - 2.38-7.14%. This study provides robust evidence that BMI significantly impacts metabolic biomarkers, which in turn affect the risk of cholelithiasis. These findings highlight the importance of managing BMI to mitigate metabolic dysfunction and reduce the risk of gallstone formation. Future research should explore the specific metabolic pathways involved to identify potential therapeutic targets.

Gallstones increase the risk of nonalcoholic fatty liver: A case-control study

Background

Nonalcoholic fatty liver disease (NAFLD) and gallstones are generally seen together, and many of the risk factors for fatty liver and gallstones are common and similar. Therefore, this study aims to investigate the relationship between NAFLD and gallstones.

Methods

This case-control study was conducted in patients referred to Imam Khomeini and Golestan hospitals of Ahvaz University of Medical Sciences in 2023, whose ultrasound showed fatty liver. Patients who were diagnosed with NAFLD by ultrasound were considered as the case group, and patients who did not have diagnostic findings of fatty liver in ultrasound were considered as the control group. Finally, the information recorded in the checklists was statistically analyzed using SPSS version 26 (SPSS Inc.).

Results

Three hundred patients were included in our study, 150 as cases and 150 as controls. There was no significant difference between the groups in terms of gender and age (gender P-value: 0.817/age P-value: 0.102). A statistically significant relationship was found between obesity, diabetes mellitus (DM), the presence of gallstones, and NAFLD (weight p-value < 0.001/DM p-value < 0.001/gallstones P-value: 0.03). In addition, based on binary logistic regression analysis, the presence of gallstones increases the odds of NAFLD by 2.33 times (P-value: 0.035). Furthermore, having DM and increasing each BMI unit increases the odds of NAFLD by 16 times and 30%, respectively (BMI p-value < 0.001/DM p-value < 0.001).

Conclusion

Based on the results of our study, gallstones are an important risk factor for NAFLD. The possible mechanisms are the existence of common risk factors between gallstones and NAFLD and the reduction of motility and flow of bile in the bile ducts with the presence of gallstones.

Association between Neutrophil-to-high-density lipoprotein-cholesterol ratio and gallstones: insights from the national health and nutrition examination survey (2017-2020)

BACKGROUND

Inflammatory responses and lipid metabolism make vital impacts on the development of gallstones. This study investigated the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.

METHODS

The data analyzed were sourced from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and comprised of participants with complete data on GSD and NHR. The relationship between NHR and GSD was evaluated with weighted multivariable logistic regression analysis. Additionally, subset analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were conducted.

RESULTS

Among the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06. The fully adjusted multivariable logistic regression results demonstrated an obvious positive association between NHR and the likelihood of GSD (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197). Consistency of this association was confirmed through subset analyses and interaction tests across various subgroups, including those categorized by smoking status and asthma. Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.

CONCLUSIONS

NHR shows a positive relationship to an increased likelihood of GSD among Americans. It can act as an easy and cost-effective tool for the early detection and management of individuals at risk for GSD.

Liver Function-Related Indicators and Risk of Gallstone Diseases-A Multicenter Study and a Systematic Review and Meta-Analysis

Purpose of the study: We aim to examine the association between liver function-related indicators and gallstone disease (GSD) risk. Study design: The subjects who participated in the China Multicenter Physical Examination Cohort (CMPEC) were enrolled. Relative odds ratios (ORs) with 95% CIs and standardized mean differences (SMDs) were applied to investigate the effect of liver function-related indicators and GSD risk. Moreover, a systematic review and meta-analysis were conducted until July 2021. Additionally, the results in the CMPEC and the systematic review and meta-analysis were combined by meta-analysis. Finally, the results were validated by a cohort study of the UK Biobank (UKB). Results and conclusions: Totally, 369,931 subjects in CMPEC were included in the study. A total of 28 publications were incorporated into the systematic review and meta-analysis. The pooled analysis suggested that aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total protein (TP), and low albumin (ALB) were positively associated with the risk of GSD. Meanwhile, GSD present to have higher AST, ALT, gamma-glutamyl transferase (GGT), total bilirubin (TBil), globulin (G), and ALP levels and relatively lower TP and ALB levels than the healthy participants. These results were consistent when stratified by the study design, geographic background, and study quality. Only the association between ALP and GSD risk was validated in the UKB cohort. This study suggests liver function indicators were associated with GSD risk. The results may provide the basis for exploring the etiology of GSD and may help clinicians identify high-risk subjects. Trial Registration: PROSPERO (CRD42020179076).

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.

Dietary fatty acids and gallstone risk: insights from NHANES and Mendelian randomization analysis

BACKGROUND

Prior research suggests polyunsaturated fatty acids (PUFA) may prevent gallstones, but evidence on saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) is limited. This study aims to explore the associations between fatty acids and gallstones using a large sample of American population and Mendelian randomization (MR) methods.

METHODS

The cross-sectional study involved 6,629 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Logistic regression and restricted cubic spline (RCS) analysis were conducted after stratifying by gender subgroups. Two-sample MR analysis was used to explore the causal relationship between fatty acids and gallstones without confounding factors.

RESULTS

In females, higher SFA intake was positively associated with gallstone risk, while higher intake of n-3 and n-6 PUFA was negatively associated. No significant associations were found in males. No nonlinear correlations were found in any group by RCS analysis. MR analysis indicated that SFA, n-3, and n-6 PUFA could reduce gallstone risk.

CONCLUSION

The influence of dietary fatty acid composition on gallstone development differs by gender, providing insights into dietary prevention and treatment of gallstones.

The Association between Healthy Eating Index-2015 and Serum Metabolic Parameters in Women with Gallstone Disease: A Case-Control Study

Background

One of the most prevalent gastrointestinal tract ailments is gallstone disease (GD). Diet has been acknowledged as a modifiable GD risk factor. The Healthy Eating Index (HEI) is a scale for evaluating the quality of diets; therefore, this study aimed to determine whether the HEI-2015 score was associated with serum metabolic parameters in women with GD.

Methods

This case-control study was conducted on a sample of 75 women diagnosed with GD and 75 healthy women at the Gastroenterology and Hepatology Clinic of Shahid Beheshti University of Medical Science in Tehran, Iran. Standard laboratory methods were employed to measure the biochemical parameters. The participants' habitual dietary intake was assessed using a validated food frequency questionnaire (FFQ). The HEI-2015 score was computed for all participants. The study employed multivariate logistic regression to identify the optimal predictor of GD. The Pearson Correlation was employed to determine the correlation between the HEI-2015 and serum metabolic parameters.

Results

The study found a significant negative association between the risk of GD and serum HDL-c (OR: 0.84; 95% CI: 0.76-0.95, P=0.008). Moreover, a significant positive association was detected between HOMAIR (OR: 3.27; 95% CI: 1.16-9.19, P=0.025), and the risk of GD. The study did not find a statistically significant correlation between the HEI-2015 and serum parameters.

Conclusion

While an association was discovered between certain serum metabolic parameters and the risk of GD, the results do not provide a significant association between serum metabolic parameters and HEI-2015 score.

Real world study on elexacaftor-tezacaftor-ivacaftor impact on cholesterol levels in adults with cystic fibrosis

INTRODUCTION

The introduction of the highly effective modulator therapy elexacaftor-tezacaftor-ivacaftor (ETI) has revolutionized the care of persons with cystic fibrosis (PwCF) with major improvements seen in lung function and body mass index. The effects of ETI therapy in real-world cohorts on other parameters such as cholesterol levels are largely unknown.

METHODS

A single-center, retrospective chart review study was conducted to assess the change in lipid panels before and after ETI initiation. The study investigated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels using both a univariate and multivariate mixed-effects model to evaluate the change after initiation of ETI in a cohort of PwCF.

RESULTS

There were 128 adult PwCF included in the analysis. Statistically significant changes were seen in both univariate and multivariate analyses for TC, LDL-C, and HDL-C. On multivariate analysis, TC increased by an average of 15.0 mg/dL after ETI initiation (p < 0.0001), LDL-C increased by an average of 9.3 mg/dL (p < 0.001), and HDL-C increased by an average of 3.8 mg/dL (p < 0.001) after ETI initiation.

CONCLUSION

In this real-world cohort of PwCF, cholesterol parameters increased after initiation with ETI therapy. Further consideration may need to be given for PwCF in regards to screening for cardiometabolic risk factors as PwCF age as well as the potential need for cholesterol-lowering therapies.

Novel insights into causal effects of serum lipids and lipid-modifying targets on cholelithiasis

OBJECTIVE

Different serum lipids and lipid-modifying targets should affect the risk of cholelithiasis differently, however, whether such effects are causal is still controversial and we aimed to answer this question.

DESIGN

We prospectively estimated the associations of four serum lipids with cholelithiasis in UK Biobank using the Cox proportional hazard model, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Furthermore, we estimated the causal associations of the genetically predicted serum lipids with cholelithiasis in Europeans using the Mendelian randomisation (MR) design. Finally, both drug-target MR and colocalisation analyses were performed to estimate the lipid-modifying targets' effects on cholelithiasis, including HMGCR, NPC1L1, PCSK9, APOB, LDLR, ACLY, ANGPTL3, MTTP, PPARA, PPARD and PPARG.

RESULTS

We found that serum levels of LDL-C and HDL-C were inversely associated with cholelithiasis risk and such associations were linear. However, the serum level of TC was non-linearly associated with cholelithiasis risk where lower TC was associated with higher risk of cholelithiasis, and the serum TG should be in an inverted 'U-shaped' relationship with it. The MR analyses supported that lower TC and higher TG levels were two independent causal risk factors. The drug-target MR analysis suggested that HMGCR inhibition should reduce the risk of cholelithiasis, which was corroborated by colocalisation analysis.

CONCLUSION

Lower serum TC can causally increase the risk of cholelithiasis. The cholelithiasis risk would increase with the elevation of serum TG but would decrease when exceeding 2.57 mmol/L. The use of HMGCR inhibitors should prevent its risk.

Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone

BACKGROUND

Pigment gallstones are not uncommon among patients with chronic haemolytic anaemia. But their clinical characteristics have not been described in detail and not been directly compared with the general gallstone population.

METHODS

Patients at Peking Union Medical College Hospital with haemolytic anaemia and subsequent gallstones from January 2012 to December 2022 were included. Cases were matched (1:2) based on age, sex and location of stones to randomly select non-anaemia patients with gallstones (controls).

RESULTS

Screening 899 cases of gallstones, we finally included 76 cases and 152 controls. Total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) for cases were 3.02 ± 0.98 mmol/L, 0.89 ± 0.30 mmol/L and 1.58 ± 0.70 mmol/L, respectively, significantly lower than those in the control group (all p < 0.001). TC and HDL were both lower than the normal range, but triglyceride and LDL were within the normal range. Multiple stones were significantly more common for cases (n = 59, 78%) than for controls (n = 44, 29%, p < 0.001). The mean diameter of the maximal gallstone was 1.2 ± 0.6 cm and 1.5 ± 1.0 cm for cases and controls (p = 0.120), respectively. Stones in the elderly (p = 0.002 for univariate analysis, and 0.001 for multivariate analysis) and stones in the bile duct (p = 0.005 for univariate analysis, and 0.009 for multivariate analysis) were found to occur in a shorter period after anaemia.

CONCLUSION

The lipid profile of haemolytic anaemia with gallstones was distinct, low TC, low HDL, and increased-to-normal LDL, compared with the general gallstone population. Patients with haemolytic anaemia were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits.KEY MESSAGESClinical characteristics of gallstones following chronic haemolytic anaemia were described and compared with the general gallstone population.The lipid profiles were distinctly different between the patients with gallstones following chronic haemolytic anaemia and the general gallstone population.Elder patients were complicated with gallstones in a shorter period after anaemia and thus were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits.

The Impact of Metabolic Factors and Lipid-Lowering Drugs on Common Bile Duct Stone Recurrence after Endoscopic Sphincterotomy with Following Cholecystectomy

BACKGROUND

Recurrent common bile duct stone after endoscopic retrograde cholangiopancreatography is an undesirable problem, even when a following cholecystectomy is carried out. Important factors are the composition and properties of stones; the most significant etiology among these is the lipid level. While numerous studies have established the association between serum lipid levels and gallstones, no study has previously reported on recurrent common bile duct stones after endoscopic sphincterotomy with following cholecystectomy.

MATERIALS AND METHODS

We retrospectively collected 2016 patients underwent endoscopic sphincterotomy from 1 January 2015 to 31 December 2017 in Linkou Chang Gung Memorial Hospital. Finally, 303 patients whose serum lipid levels had been checked following a cholecystectomy after ERCP were included for analysis. We evaluated if metabolic factors including body weight, BMI, HbA1C, serum lipid profile, and lipid-lowering drugs may impact the rate of common bile duct stone recurrence. Furthermore, we tried to find if there is any factor that may impact time to recurrence.

RESULTS

A serum HDL level ≥ 40 (p = 0.000, OR = 0.207, 95% CI = 0.114-0.376) is a protective factor, and a total cholesterol level ≥ 200 (p = 0.004, OR = 4.558, 95% CI = 1.625-12.787) is a risk factor of recurrent common bile duct stones after endoscopic sphincterotomy with cholecystectomy. Lipid-lowering drugs, specifically statins, have been shown to reduce the risk of recurrence significantly (p = 0.003, OR = 0.297, 95% CI = 0.132-0.665). No factors were found to impact the time to recurrence in this study.

CONCLUSIONS

The serum lipid level could influence the recurrence of common bile duct stones after endoscopic sphincterotomy followed by cholecystectomy, and it appears that statins can reduce the risk of recurrence.

Hyodeoxycholic acid attenuates cholesterol gallstone formation via modulation of bile acid metabolism and gut microbiota

BACKGROUND & AIMS

Hyodeoxycholic acid (HDCA), a hydrophilic bile acid (BA), may prevent and suppress the formation of cholesterol gallstones (CGs). However, the mechanism by which HDCA prevents CGs formation remains unclear. This study aimed to investigate the underlying mechanism of HDCA in preventing CG formation.

METHODS

C57BL/6J mice were fed either a lithogenic diet (LD), a chow diet, or LD combined with HDCA. The concentration of BAs in the liver and ileum were determined using liquid chromatography-mass spectrometry (LC-MS/MS). Genes involved in cholesterol and BAs metabolism were detected using polymerase chain reaction (PCR). The gut microbiota in the faeces was determined using 16S rRNA.

RESULTS

HDCA supplementation effectively prevented LD-induced CG formation. HDCA increased the gene expression of BA synthesis enzymes, including Cyp7a1, Cyp7b1, and Cyp8b1, and decreased the expression of the cholesterol transporter Abcg5/g8 gene in the liver. HDCA inhibited LD-induced Nuclear farnesoid X receptor (Fxr) activation and reduced the gene expression of Fgf15 and Shp in the ileum. These data indicate that HDCA could prevent CGs formation partly by promoting BA synthesis in the liver and reduced the cholesterol efflux. In addition, HDCA administration reversed the LD-induced decrease in the abundance of norank_f_Muribaculaceae, which was inversely proportional to cholesterol levels.

CONCLUSIONS

HDCA attenuated CG formation by modulating BA synthesis and gut microbiota. This study provides new insights into the mechanism by which HDCA prevents CG formation.

LAY SUMMARY

In this study, we found that HDCA supplementation suppressed LD-induced CGs in mice by inhibiting Fxr in the ileum, enhancing BA synthesis, and increasing the abundance of norank_f_Muribaculaceae in the gut microbiota. HDCA can also downregulate the level of total cholesterol in the serum, liver, and bile.

Identification of Intestinal Microbial Community in Gallstone Patients with Metagenomic Next-Generation Sequencing

Gallstone disease (GD) is one of the most common gastrointestinal diseases worldwide. Nowadays, intestinal microbiota are thought to play important roles in the formation of gallstones. In our study, human fecal samples were extracted for metagenomic next-generation sequencing (mNGS) on the Illumina HiSeq platform, followed by bioinformatics analyses. Our results showed that there was a particular intestinal micro-ecosystem in GD patients. In contrast to healthy people, the sequences of Bacteroidetes, Bacteroides and Thetaiotaomicron were obviously more abundant in GD patients at phylum, genus and species levels, respectively. On the other hand, the glycan metabolism and drug resistance, especially for the β-lactams, were the most profound functions of gut microbes in GD patients compared to those in normal subjects. Furthermore, a correlation analysis drew out that there existed a significant relationship between the serum levels of biochemical indicators and abundances of intestinal microbes in GD patients. Our results illuminate both the composition and functions of intestinal microbiota in GD patients. All in all, our study can broaden the insight into the potential mechanism of how gut microbes affect the progression of gallstones to some extent, which may provide potential targets for the prevention, diagnosis or treatment of GD.

Associations of long-term exposure to particulate matter with gallstone risks in Chinese adults: A large cross-sectional study

BACKGROUND

Epidemiological evidence regarding the relation of exposure to ambient particulate matter (PM) with gallstone disease (GSD) risk remains lacking. We tested the hypothesis that long-term exposure to PM is related to the development of GSD and that dyslipidemia can mediate the effect of PM-associated GSD formation.

METHODS

We extracted related information on the basis of the baseline survey of the China Multi-Ethnic Cohort Study. The exposure levels of PM (PM₁, PM_2.5, and PM₁₀) were assessed by validated spatiotemporal models. The relation of exposure to ambient PM with GSD risks was analyzed by non-conditional logistic regression models. Additionally, mediation analysis was conducted to assess whether dyslipidemia was related to the relation of PM exposure with GSD risks.

RESULTS

A total of 72,893 participants were included. Increased ambient PM exposure was positively associated with a higher GSD risk, with ORs (and 95% CI) of 1.17 (1.06, 1.28), 1.10 (1.05, 1.15), and 1.07 (1.04, 1.10) for every 10 μg/m³ increment in PM₁, PM_2.5, and PM₁₀, separately. The association was more remarkable in males, drinkers, and central obesity participants. Dyslipidemia significantly mediated the association between PM and GSD, with mediating proportions of 5.37%, 9.13%, and 7.66% in PM₁, PM_2.5, and PM₁₀, respectively.

CONCLUSION

Exposure to PM may relate to the increased risk of GSD in Chinese adults, especially among males, drinkers, and central obesity participants. Dyslipidemia may partially mediate the effect of PM-associated GSD development. Our results might provide epidemiological evidence for the progression of GSD related to PM and give new insights into GSD prevention and screening priorities.

The potential bidirectional association between Helicobacter pylori infection and gallstone disease in adults: A two-cohort study

BACKGROUND

Previous studies have suggested that Helicobacter pylori (H. pylori) may act as a precipitating factor in gallstone formation, and the potential association between H. pylori infection and gallstone disease (GD) is still unclear and controversial. This study aimed to clarify the potential bidirectional relationship between H. pylori infection and GD.

METHODS

This retrospective cohort study was performed in a population that underwent health checkups at the hospital between 2013 and 2018. H. pylori infection status was evaluated by urea breath test (UBT), and GD was diagnosed via ultrasound. Cox regression and propensity score matching (PSM) were used.

RESULTS

Among 1011 participants without H. pylori infection at baseline, 134 participants were infected with H. pylori. Among 1192 participants without gallstones or cholecystectomy at baseline, 60 participants developed gallstones or cholecystectomy. The hazard ratio (HR) (95% CI) for incident H. pylori infection comparing the GD versus the no GD group was 1.84 (1.19, 2.85). The age- and sex-adjusted HR (95% CI) for incident GD comparing H. pylori-positive subjects to H. pylori-negative subjects was 1.74 (1.01, 2.98). Consistent results were also found with PSM and multivariate analysis.

CONCLUSIONS

This cohort study demonstrated a potential bidirectional association between H. pylori infection and GD, which provides a basis for indicating the risk of GD and implementing the clinical strategies for GD. For the prevention and treatment of GD, H. pylori infection should be carefully considered and evaluated.

Lipid profile, apolipoproteins A-1 and B in owl monkeys (Aotus infulatus) in captivity

BACKGROUND

Owl monkeys (Aotus infulatus) are frequently affected by heart diseases and, as in humans, dyslipidemia is one of the predisposing factors for adverse cardiovascular events. In view of this, the study of the lipid profile and plasma apolipoproteins can contribute to the clinical management of this neotropical primate species.

METHODS

Lipid profile as well as A-1 and B apolipoprotein values were analyzed in 60 owl monkeys, studying their relationship with body biometry and the presence of cardiac alterations.

RESULTS

Animals suspected of having heart disease did not show significant differences (p < .05) in terms of biometry or in relation to lipid profile and apolipoproteins A-1 and B values; however, higher values of LDL and ApoB and ApoB/ApoA-1 were observed in this group.

CONCLUSIONS

This study is the first to describe the lipid profile and apolipoprotein values in owl monkeys, and further work will be needed to better elucidate the worthiness of LDL, ApoB, and the ApoB/ApoA-1 ratio in this primate species.