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Dietary Factors Influencing the Pathogenesis of Gallstone Disease in Kerala, India |
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TG Raghu 1. Associate Professor, Department of Surgery, Sreenarayana Institute of Medical Sciences, Ernakulam, Kerala, India. |
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Correspondence Address : TG Raghu, Dr. TG Raghu, Sreenarayana Institute of Medical Sciences, P.O. Chalakka, Ernakulam District-683594, Kerala, India. E-mail: drmeenakshitripathi1@gmail.com |
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| ABSTRACT |  | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
: Introduction: Increased consumption of meat is associated with gallstone ailment as intake of non-vegetarian food increases biliary acid, a trimethylamine transporter that tempts the gallstone cholesterol. Aim: To determine the relationship of dietary factors with gallstones amongst Indian patients. Materials and Methods: The present study was a case-control study which was conducted at Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India from February 2008-June 2009. Study population included patients having cholelithiasis or lately identified with indicative or non-indicative gallstones. The nutritional ingestion was measured by qualified nutritionist by means of semi-quantifiable survey on food-frequency questionnaire. The subjects were matched up in age and gender proportions having analogous demographic features. The usual ultrasound of abdomen was performed by medical practitioners. Results: There were 200 patients included as cases and 200 controls, of the cases 112 (56%) were males and 88 (44%) were females, age range was 10-80 years. Preponderance was noted in age group of 31 to 40 years mounting to 52 (26%) pursued by 22.5% controls in the age groups of 21 to 30 and 41 to 50 years. According to the dietary interests, the vegetarian and non-vegetarian percentage ratio was of 21.5 and 78.5. Conclusion: The risk factors responsible for the development of Gallstone Disease (GSD) were food including meat, cholesterol, tamarind, and squat in fibre. In case of such ailments, vegetarian food with suggested calories and should be encouraged. Therefore, the anticipatory measures like amendments in routine and food should be carried out to eradicate these hazardous factors. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Cholesterol, Dietary factors, Gall stone disease, Pathogenesis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2021/46214:2615
Date of Submission: Aug 06, 2020 Date of Peer Review: Sep 09, 2020 Date of Acceptance: Oct 11, 2020 Date of Publishing: Apr 01, 2021 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METH |
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| INTRODUCTION |
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Cholelithiasis or Gallstone Disease (GSD) portrays significant burden for healthcare structure globally. It is also considered as one of the most common disorders among patients with abdominal discomfort including epigastric pain, nausea, loss of appetite, vomiting etc (1),(2). Majority of non-indicative or asymptomatic patients with gallstones, have reported as an accidental finding through scheduled health check-up or for a dissimilar medical problem (3),(4),(5). Currently, gallbladder ailment is a common trouble in developed nations as well as in countries like India (6). The cause for such diseases might be enormous (7). GSD is a chronic recurrent hepatobiliary disease, caused by impaired metabolism of cholestrol, bile acids and bilirubin resulting in development of gallstones in the bile duct or gallbladder and hepatic bile duct (8). Gallstones are chiefly categorised as pigment and cholesterol gallstones; cholesterol gallstones are more than pigment gallstones in western nations as compared to Asian population (9). Varied and pigment gallstones are very common in the southern region of India [10-13]. While cholesterol gallstones are common in the northern part of the nation (14),(15),(16),(17). In a preceding epidemiological research, it was observed that demographic and social variables do not confer to the composition of pigment gallstone (18). Expansion of cholesterol gallstones is correlated to infiltration of cholesterol in bile as well as in gallbladder stasis (19). Pigment gallstones expand from the liberation of ß-glucuronidase (20). (Table/Fig 1) shows pathogenesis of gallstone formation. The factors pertaining to nutrition have been measured dominant in many studies, and this is strappingly sustained by the ruling of Pixley F et al., by means of ultrasonography, which gallstones are only short as ordinary in British vegans as in the rest of the inhabitants (21). There are numerous dissimilarities amid vegan and regular food. Nevertheless, there is no investigational validation to give away non-vegetarian food. There are several studies which stated that menace of gallstone is surely related to ingestion of non-vegetarian food, vigour, fat and inundated fat. However, it is also connected with ingestion of veggies and fibre in Asian and western inhabitants (22),(23),(24),(25),(26),(27),(28),(29),(30),(31). Predominantly, elevated consumption of meat was connected with hazard of gallstone ailment, as eating of red meat repressed bile acid carriers by trimethylamine which encouraged cholesterol gallstone (22). Additionally, it has been reported in preceding researches that peril of gallstone was absolutely ingestion of butter, trans fatty acids, refined sugars and cooking oil, but unenthusiastically connected with reasonable ingestion of alcohol and coffee in Japanese and Western inhabitants (23),(29),(32),(33),(34). The peril of gallstone was critically linked with a vigorous nutritional prototype in women from Iran and as well as unconventional Mexican food outlines (35). The present study was done with an aim to determine the relationship of dietary factors with gallstones amongst Indian patients. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Material and Methods |
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This case control study was performed at Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India from February 2008-June 2009. Consent was taken from all the participants. Study population consisted of 400 participants, 200 case and 200 controls. Inclusion criteria: Patients undergoing investigation of gallstone illness having diagnosed as indicative or non-indicative of gallstone disease were included. Exclusion criteria: Exclusion criteria comprised of patients who underwent open cholecystectomy, biliary drainage procedure, solemn co-morbidity which needed long-term admission to the hospital; and identified with varied gallstones. The nutritional ingestion was measured by practicing dietician. A semi-quantitative questionnaire was used for the study, that included occurrence of diet particulars, character of cereal used, non-vegetarian diet, monthly oil consumption, sugar consumption per day, tamarind intake per week, and as well as regularity of every day beverage were incorporated in daily food. The subjects were matched up in age and gender proportions having analogous demographic features. The usual ultrasound of abdomen was performed by medical practitioners. STATISTICAL ANALYSIS The data was collected and analysed by using Chi-Square test and Student’s t-test and software for analysis will be SPSS version 20.0 and a p-value <0.05 was considered to be statistically significant. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Results |
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There were 200 patients included in the study as well as there were 200 controls for the analysis. Out of total, 112 (56%) were males and the rest 88 (44%) were females, with age ranging from 10-80 years. Preponderance of cases were noted in the age group were of 31 to 40 years- 52 (26%) (Table/Fig 2) followed by 22.5% controls in the age groups of 21 to 30 and 41 to 50 years. According to the dietary interests, the vegetarian and non-vegetarian percentage was of 21.5% (43) and 78.5 (157) (Table/Fig 3). There was no dietary parameter difference observed between controls and cases. A comparison has been made in (Table/Fig 4) on cases and controls which are equal in numbers. It was found that age was parallel in both the groups i.e., 38.6±8.4 vs 42.58±6.8 (years) in cases and controls correspondingly. Consumption of distinct diets was usually dispersed and allocation was analogous in both i.e., cases and controls while making an allowance for dietary intake for non-vegetarians and vegetarians. However, dissimilarities appeared as displayed in the (Table/Fig 5). 2A total of 95% CI for gallstone ailment as per the nutritional outline sort is displayed in (Table/Fig 6). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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According to this study, there are many dietary causes that are very significant in the aetiology of gallstones. Predominantly, a high intake of drenched fats and refined sugar can possibly amplify the risk of gallstone configuration, while an elevated ingestion of saturated fats, and nutritional cholesterol might guard against gallstone creation. Furthermore, the risk of cholesterol gallstone was connected with nutritional prototype having pork, fried food; beef etc., whereas there was no relationship between menace of pigment gallstone and nutritional model. The function of dietary factors in cholesterol gallstones has been described by many authors (36),(37). The chief hazard issue incorporated drawn out fasting, low-calorie diet, stoutness, edible oil, refined sugar and high calorie intake (38),(39),(40),(41),(42). Obesity was established as an imperative jeopardy reason for gallstones verifying the conclusion of numerous studies done previously (43),(44),(45),(46). Gallstone ailment is caused by deposit of hard fat or mineral in the gallbladder. In this ailment, the stones block part of biliary mechanism and create exasperation of gallbladder and difficulties. This disarray can source life intimidating circumstances, if left untreated (47). The ingestion of food (non-vegetarian or vegetarian) does not influence the incidence of gallstones (16),(48). This study has displayed a noteworthy alliance between intake of tamarind more than three times a week and the incident of gallstones ailment. Consumption of oil too did not influence gallstone ailment. Population of Kerala consume beverages like tea and coffee in high amount; however, this did not lead to gallstone ailment by exciting for the emission of cholecystokinin causing increased gallbladder motility. Intake of sugar was also not causative. Though, there is an inspection of less than 15 g sugar consumption per day being connected with advanced peril for gallstone ailment (29),(43). This study found an enlarged menace of GSD with towering ingestion of solid fat, non-vegetarian food, and egg within the damaging nutritional outline structure. There are many studies which have displayed an elevated total fat and saturated fat consumption among patients with cholelithiasis and propose an aetiological role for these nutritional mechanism (49),(50). There are many researches that have recommended that red meat and egg-yolk animal protein, animal fat as well as nutritional cholesterol augment the biliary cholesterol saturation and encourage cholesterol gallstones,which is also established in this work (48),(51),(52),(53),(54),(55),(56). New perspectives for a better understanding of the role of dietary constituents on cholesterol gallstone formation have significantbeen unfastened in latest findings of the role of orphan nuclear receptors in the regulation of fatty acid and hepatic cholesterol metabolism and emission (57). Limitation(s) This study had small sample size. Prospective study with a larger population are required, under strict supervisions of subjects these perspectives would have better understanding of the role of dietary factors for the gallstone formation and gallstones diseases. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Original article / research
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