NUTRITIONAL AND EPIDEMIOLOGICAL CAUSES OF CHOLELITHIASIS: A CROSS SECTIONAL STUDY OF THE PARADIGM SHIFT IN THE RISK FACTORS AT KHYBER PAKHTUNKHWA
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Keywords
Cholelithiasis, socio-demographic factors, dietary intake patterns, anthropometry, macronutrients, Physical activity
Abstract
Cholelithiasis has been regarded as one of the one of the most prevalent disease in the gastrointestinal disorders with a larger disease and emergency surgical burden. Many factors contribute to the development of gall stones; genetic and predominantly dietary and life style factors. No such studies have previously been done to determine the contributing risk factors of cholelithiasis in Khyber Pakhtunkhwa.
OBJECTIVES: (1). To determine the socio demographic risk factors of cholelithiasis at district
Peshawar, Pakistan. (2). To analyze the dietary intake patterns, macronutrient densities of the diets, and physical activity patterns of the patients
METHODS: A total of 125 patients (being calculated at 95% confidence interval and 1% odds ratio) were recruited after written consents. Gall stones and their sizes were confirmed by ultrasonography. Socio demographic characteristics, anthropometric measurements, biochemical tests for liver function, clinical symptoms of malnutrition and disease associated were examined, Food frequency (daily, weekly, monthly) for different food groups were considered. Based on 72 hours recall mean macronutrient intakes, their percent contribution to daily energy intakes, and physical activity patterns were analyzed through WHO standardized IPAQ tool. Data was analyzed through SPSS for both continuous and categorical variables.
RESULTS: Among the study sample 95.4% patients were females, 97% married, 64% females, illiterate and 92% being housewives. Data of the male patients and husbands of the female patients collectively 53% were illiterate with low paid jobs while some were engaged in some government jobs. About 56% of the sample were living in extended family system, having children in the 5-9 category with the most common family size of 10-14 members (56%). About 55.2 % patients reported family history of gall stones. Majority of the patients had multiple stones of different sizes common being 2.2 cm. Clinical symptoms of iron and B complex vitamin deficiencies were commonly observed. Majority of the patients were referred to Ultrasonographic scans due to frequent GIT disturbances associated with gall stones. Mean age of the sample was 43.2± 21.93, while BMI (25.73 ±1.85), percent body fat (36.25±7.97) and % Visceral fat (9.45±19.76) showed a strong obesity and overweight trend (39.2% and 58.4% respectively) mainly the truncal obesity. The dietary frequency showed an overall poor food choice with higher intakes of wheat-based staples, rice, lentils, beef, chapli kabab (the local beef Pattie with herbs, spices and deep fried in tallow) and intake of seasonal cooked vegetables was common. Alarmingly most of the sample consumed white sugar and hydrogenated fat (ghee) were common. The overall consumption of energy and energy nutrients were higher while dietary protein and fiber were quite low. Physical activity patterns showed 43.8% inactive, 46.2% minimally active and 49.6% patients had >5 sitting hours. The data showed strong associations with many of the study parameters.
CONCLUSION: The current study indicated age, being female gender, multiparity, larger family sizes, obesity, poor dietary choices, inactivity as the major contributing factors of cholelithiasis in this region.
References
2. Zamani F, Sohrabi M, Alipour A, et al.Prevalence and risk factors of cholelithiasis in Amol city, northern Iran: a population based study. Arch Iran Med. 2014; 17:750–754
3. Bilal M, Haseeb A, Sand M, Ahsan M, Raza M, Ahmad A, Shahnawaz W, Ahmad B, Motiani V. The prevalence and risk factors of Gallstone among Adults in Karachi, South Pakistan: A Population-Based study. Global Journal of Health Science. 2016; 9(4), 106-114
4. Afridi R G F and Batool Z. Patho-morphological classes of Gallstones, their frequency and etiological factors in Peshawar, KP, Pakistan, 2015; JRMI 1(1), 29-34
5. Pradhan SB, Joshi M, Vaidya A. Prevalence of different types of gallstones in the patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu university medical journal. 2009;7(3):268-71
6. Abu-Eshy SA, Mahfouz AA, Badr A, El Gamal MN, Al-Shehri MY, Salati MI, Rabie ME. Prevalence and risk factors of gallstone disease in a high-altitude Saudi population. East Mediterr Health J. 2007; 13:794–802.
7. Gençtoy G, Ayidağa S, Ergun T, Lakadamyalı H, Erbayrak M, Sezer S. Increased frequency of gallbladder stone and related parameters in hemodialysis patients. Turk J Gastroenterol. 2014; 25:54–58.
8. Alghaiti, M, S. Alshammari, H, J. Alshammari, T, F. Alshammari, N, F. Al-Muzaini, Y, A. Alsudayri, T, S, M. Alshammari, J, A. Prevalence and risk factors for Gallstone disease in Hail Region. The Egyptian journal of Hospital Medicine. 2017; 70X4), 703-707
9. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6: 172–187.
10. Ansari-Moghaddam A, Khorram A, Miri-Bonjar M, Mohammadi M, Ansari H. The prevalence and risk factors of gallstone among adults in South-East of Iran: A population-based study. Global journal of health sciences. 2017; 8(4), 60-67.
11. Buckingham IJ, Krige JE. ABC of diseases of liver, pancreas, and biliary system. BMJ (Clinical research ed). 2001 2001/02//;322(7284):477-80
12. Lin Y-M, Chen Y-H, Hu N-C, Liao C-S, Chen J-H, Yang K-C. The association of age, gender and metabolic factors with gallstone disease. Taiwan Journal of Digestive Medicine. 2011;28(4):331-8.
13. Bhatti YA, Waqar BA, Zia A S, Hussain N, Zulfiqar T. A cross- sectional study on the risk factors of Gallbladder stone. International journal of research in medical sciences, 2016; 4(11). 5041-5046.
14. Ahmed W, Iqbal M, Ahmed 1. Is there any change in Demographic Pattern of Patients with Cholelithiasis? Isra medical journal. 2017; 9(2), 75-79
15. Channa, A N. Gallstone disease: A review. Pakistan armed forces medical journal. 2008; 58(2).
16. Shiwaku K, Anuurad E, Enkhmaa B, Kitajima K, Yamane Y. Appropriate BMI for Asian populations. Lancet. 2004; 27;363(9414):1077. PMID: 15051297.
17. The U.S. Agency for International Development through the Food and Nutrition Technical Assistance III Project (FANTA). Global MUAC Cutoffs for Adults: A Technical Consultation.
https://www.fantaproject.org/sites/default/files/resources/FANTA-MUAC-Cutoffs-Consultation-2018.pdf
18. Craig C L, Marshall A, Sjostrom M, Bauman A, Booth M. Ainsworth, B. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35: 1381–1395
19. Zamil AL, Abbas SA, Yaqoob QA. Study of Prevalence and risk factors of Cholelithiasis in female patients in Misan Province/Iraq. A single center study. PJMHS. 2021;15(1):281
20. Jørgensen T. Gall stones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones. Gut. 1988; 29(4):433-9.
21. Völzke H, Baumeister SE, Alte D, Hoffmann W, Schwahn C, Simon P. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71(2):97-105.
22. Khan ZA, Khan MU, Brand M. Increases in cholecystectomy for gallstone related disease in South Africa. Scientific Reports. 2020;10(1):1-5.
23. Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. Hepatology. 1988;8(4):907-13
24. Mazyad MS, Abdul-Ghafoor BH. Study the predicators and risk factors for formation of gallstones in a sample of asymptomatic Iraqi patients in Baghdad. Int Surg J 2023; 10:829-36.
25. Herzog D, Bouchard G. High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center. World J Gastroenterol.2008;14:1544–1548.
26. Constantinescu T, Huwood Al Jabouri AK, Brãtucu E, Olteanu C, Toma M, Stoiculescu A. Gallstone disease in young population: incidence, complications, therapeutic approach. Chirurgia (Bucur) 2012; 107:579–582.
27. Nakeeb A, Comuzzie AG, Martin L, Sonnenberg GE, Swartz-Basile D, Kissebah AH, Pitt HA. Gallstones: genetics versus environment. Ann Surg. 2002; 235(6):842-9
28. Dadhich Y, Bhardwaj G, Goel G, Mandia R. Correlation of serum iron and ferritin levels in patients of cholelithiasis and comparison with healthy individuals. Int J Surg. 2019;6(6):1981-6.
29. Johnston SM, Murray KP, Martin SA, Foxtalbot K, Lipsett PA, Pitt HA. Iron deficiency enhances cholesterol gallstone formation. Surgery. 1997;122(2):354-61.
30. Misra PK, Kumawat S, Kharb S. Role of trace elements in the formation of gall stones. Asian J Biochem. 2014; 9:213-20.
31. Jones MW, Weir CB. Ghassemzadeh S. Gallstones (Cholelithiasis). 2024. StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books.
32. Field AE, Coakley EH, Must A. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161(13):1581–1586.
33. Field AE, Coakley EH, Must A. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161(13):1581–1586.
34. Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Central adiposity, regional fat distribution, and the risk of cholecystectomy in women. Gut. 2006;55(5):708–714.
35. Sattar I, Aziz A, Rasul S, Mehmood Z, Khan A. Frequency of Infection in Cholelithiasis JCPSP. 2007; 17 (1): 48-50
36. Naeem M, Rahimnajjad NA, Rahimnajjad MK, Khurshid M, Ahmed QJ, Shahid SM, Khawar F, Najjar MM. Assessment of characteristics of patients with cholelithiasis from economically deprived rural Karachi, Pakistan. BMC Res Notes. 2012; 28; 5:334.
37. Schwesinger WH, Kurtin WE, Page CP. Soluble dietary fiber protects against cholesterol gallstone formation. Am Surg J. 1999;177(4):307–10
38. Misciagna G, Centonze S, Leoci C. Diet, physical activity and gallstones — a population-based case–control study in southern Italy. Am J Clin Nutr. 1999; 69:120–6.
39. Hou L, Shu X O, Gao Y T, Ji BT, Weiss J M, Yang G. Anthropometric measurements, physical activity, and the risk of symptomatic gallstone disease in Chinese women. Ann. Epidemiol. 2009; 19 (5), 344–350
40. Mok A, Khaw K T, Luben R, Wareham N,Brage S. Physical activity trajectories and mortality: Population based cohort study. BMJ. 2019; 365, l2323.
41. Su PY, Hsu YC, Cheng YF, Kor CT, Su WW. Strong association between metabolically-abnormal obesity and gallstone disease in adults under 50 years. BMC Gastroenterol. 2019;19((1)):117.
42. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000
43. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA. International Diabetes Federation Task Force on Epidemiology and Prevention. Hational Heart, Lung, and Blood Institute. American Heart Association. World Heart Federation. International Atherosclerosis Society. International Association for the Study of Obesity Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120((16)):1640–5
44. Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. Lancet. 2006; 368((9531)):230–9.
45. Sahi T, Paffenbarger RS, Jr, Hsieh CC, Lee IM. Body mass index, cigarette smoking, and other characteristics as predictors of self-reported, physician-diagnosed gallbladder disease in male college alumni. Am J Epidemiol. 1998;147((7)):644–51
46. Freeman JB, Meyer PD, Printen KJ, Mason EE, DenBesten L. Analysis of gallbladder bile in morbid obesity. Am J Surg. 1975;129((2)):163–6.
47. Di Ciaula A, Wang DQ, Portincasa P. Gallbladder and gastric motility in obese newborns, pre-adolescents and adults. J Gastroenterol Hepatol. 2012; 27((8)):1298–305
48. 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 Intern Med. 2004;141((7)):514–22
49. Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Long-term intake of trans-fatty acids and risk of gallstone disease in men. Arch Intern Med. 2005;165((9)):1011–5.
50. Sai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Long-chain saturated fatty acids consumption and risk of gallstone disease among men. Ann Surg. 2008; 247((1)):95–103
51. Ortega RM, Fernández-Azuela M, Encinas-Sotillos A, Andrés P, López-Sobaler AM. Differences in diet and food habits between patients with gallstones and controls. J Am Coll Nutr. 1997;16((1)):88–95
52. Misciagna G, Centonze S, Leoci C, Guerra V, Cisternino AM, Ceo R. Diet, physical activity, and gallstones—a population-based, case-control study in southern Italy. Am J Clin Nutr. 1999; 69((1)):120–6.
53. Leitzmann MF, Giovannucci EL, Rimm EB, Stampfer MJ, Spiegelman D, Wing AL, The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998;128((6)):417–25
54. Leitzmann MF, Rimm EB, Willett WC, Spiegelman D, Grodstein F, Stampfer MJ. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999; 341((11)):777–84.
55. Storti KL, Brach JS, FitzGerald SJ, Zmuda JM, Cauley JA, Kriska AM. Physical activity and decreased risk of clinical gallstone disease among post-menopausal women. Prev Med. 2005; 41((3-4)):772–7.
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Dr. Fazia Ghaffar
Department Of Food & Nutrition Sciences University Of Peshawar Peshawar, Pakistan