Abstract
Background/Objectives:
Previous small studies have shown either no difference or a lower risk of symptomatic gallstone disease in vegetarians than in non-vegetarians. This study examined the incidence of symptomatic gallstone disease in a cohort of British vegetarians and non-vegetarians, and investigated the associations between nutrient intake and risk of symptomatic gallstone disease.
Subjects/Methods:
The data were analysed from 49 652 adults enroled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian. The linked databases of hospital records were used to identify incident cases. Risk by diet group was estimated using Cox proportional hazards models. Further analysis quantified risk by intakes of selected macronutrients.
Results:
There were 1182 cases of symptomatic gallstone disease during 687 822 person-years of follow-up (mean=13.85 years). There was a large significant association between increasing body mass index (BMI) and risk of developing symptomatic gallstone disease (overall trend P<0.001). After adjustment for BMI and other risk factors, vegetarians had a moderately increased risk compared with non-vegetarians (HR: 1.22; 95% CI: 1.06–1.41; P=0.006). Although starch consumption was positively associated with gallstones risk (P=0.002 for trend), it did not explain the increased risk in vegetarians.
Conclusions:
There is a highly significant association of increased BMI with risk of symptomatic gallstone disease. After adjusting for BMI, there is a small but statistically significant positive association between vegetarian diet and symptomatic gallstone disease.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ . EPIC–Oxford:lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr 2003; 6: 259–268.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . Dietary protein and the risk of cholecystectomy in a cohort of US women: the Nurses' Health Study. Am J Epidemiol 2004; 160: 11–18.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . Long-chain saturated fatty acids consumption and risk of gallstone disease among men. Ann Surg 2008; 247: 95–103.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . Fruit and vegetable consumption and risk of cholecystectomy in women. Am J Med 2006; 119: 760–767.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . Dietary carbohydrates and glycaemic load and the incidence of symptomatic gall stone disease in men. Gut 2005; 54: 823–828.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . Long-term intake of trans-fatty acids and risk of gallstone disease in men. Arch Internal Med 2005; 165: 1011–1015.
Tsai CJ, Leitzmann MF, Hu FB, Willett WC, Giovannucci EL . A prospective cohort study of nut consumption and the risk of gallstone disease in men. Am J Epidemiol 2004; 160: 961–968.
Tsai CJ, Leitzmann MF, Hu FB, Willett WC, Giovannucci EL . Frequent nut consumption and decreased risk of cholecystectomy in women. Am J Clin Nutr 2004; 80: 76–81.
Leitzmann MF, Giovannucci EL, Rimm EB, Stampfer MJ, Spiegelman D, Wing AL et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Internal Med 1998; 128: 417–425.
Sichieri R, Everhart JE, Roth H . A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting. Am J Public Health 1991; 81: 880–884.
Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Willett WC . Dietary predictors of symptom-associated gallstones in middle-aged women. Am J Clin Nutr 1990; 52: 916–922.
Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC . Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N Engl J Med 1989; 321: 563–569.
Jorgensen T, Jorgensen LM . Gallstones and diet in a Danish population. Scand J Gastroenterol 1989; 24: 821–826.
Pixley F, Mann J . Dietary factors in the aetiology of gall stones: a case control study. Gut 1988; 29: 1511–1515.
Walcher T, Haenle MM, Mason RA, Koenig W, Imhof A, Kratzer W . The effect of alcohol, tobacco and caffeine consumption and vegetarian diet on gallstone prevalence. Eur J Gastroenterol Hepatol 2010; 22: 1345–1351.
Pixley F, Wilson D, McPherson K, Mann J . Effect of vegetarianism on development of gall stones in women. Br Med J (Clin Res Ed) 1985; 291: 11–12.
Chen YC, Chiou C, Lin MN, Lin CL . The prevalence and risk factors for gallstone disease in taiwanese vegetarians. PloS One 2014; 9: e115145.
Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 1997; 26 (Suppl 1), S137–S151.
Townsend P, Phillimore P, Beattie A . Health and Deprivation: Inequality and the North. Croom Helm: London, UK, 1987.
Chen CH, Huang MH, Yang JC, Nien CK, Etheredge GD, Yang CC et al. Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey. J Gastroenterol Hepatol 2006; 21: 1737–1743.
Jayanthi V, Anand L, Ashok L, Srinivasan V . Dietary factors in pathogenesis of gallstone disease in southern India—a hospital-based case-control study. Indian J Gastroenterol 2005; 24: 97–99.
Singh V, Trikha B, Nain C, Singh K, Bose S . Epidemiology of gallstone disease in Chandigarh: a community-based study. J Gastroenterol Hepatol 2001; 16: 560–563.
Liddle RA, Goldfine ID, Rosen MS, Taplitz RA, Williams JA . Cholecystokinin bioactivity in human plasma. Molecular forms, responses to feeding, and relationship to gallbladder contraction. J Clin Invest 1985; 75: 1144–1152.
Marciani L, Cox EF, Hoad CL, Totman JJ, Costigan C, Singh G et al. Effects of various food ingredients on gall bladder emptying. Eur J Clin Nutr 2013; 67: 1182–1187.
Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL . The effect of long-term intake of cis unsaturated fats on the risk for gallstone disease in men: a prospective cohort study. Ann Internal Med 2004; 141: 514–522.
Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P et al. Incidence of gallstone disease in Italy: Results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 2008; 14: 5282–5289.
Chen J-Y, Hsu C-T, Liu J-H, Tung T-H . Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan. BMC Gastroenterol 2014; 14: 83–83.
Shabanzadeh DM, Sørensen LT, Jørgensen T . Determinants for gallstone formation – a new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol 2016; 51: 1239–1248.
Acknowledgements
We thank all the participants in the EPIC-Oxford cohort for their invaluable contribution to the study. This work is supported by the UK Medical Research Council MR/M012190/1 and Cancer Research UK 570/A16491.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
McConnell, T., Appleby, P. & Key, T. Vegetarian diet as a risk factor for symptomatic gallstone disease. Eur J Clin Nutr 71, 731–735 (2017). https://doi.org/10.1038/ejcn.2016.252
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2016.252
This article is cited by
-
The role of diet and nutrition related indicators in biliary diseases: an umbrella review of systematic review and meta-analysis
Nutrition & Metabolism (2022)
-
A summary of meat intakes and health burdens
European Journal of Clinical Nutrition (2018)