Sekine Katsunori, Nagata Naoyoshi, Sakamoto Kayo, Arai Tomohiro, Shimbo Takuro, Shinozaki Masafumi, Okubo Hidetaka, Watanabe Kazuhiro, Imbe Koh, Mikami Shintaro, Nozaki Yuichi, Sakurai Toshiyuki, Yokoi Chizu, Kojima Yasushi, Kobayakawa Masao, Yanase Mikio, Akiyama Junichi, Noda Mitsuhiko, Uemura Naomi
Departments of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
Diagnostic Radiology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
J Gastroenterol Hepatol. 2015 Aug;30(8):1325-31. doi: 10.1111/jgh.12965.
Visceral adiposity is a strong determinant of insulin resistance, which decreases cholecystokinin response sensitivity, and increases cholesterol saturation in the gallbladder bile; thus, it potentially relates to gallstone disease development. We aimed to investigate whether visceral fat measured by computed tomography (CT) is a risk factor for gallstone disease.
A cohort of 717 participants undergoing CT and ultrasonography was analyzed. The associations between body mass index (BMI), visceral adipose tissue (VAT) area, subcutaneous adipose tissue (SAT) area, and gallstone disease were analyzed adjusted for age, sex, hypertension, diabetes, and dyslipidemia.
In multivariate analysis, gallstone disease was significantly associated with VAT and SAT areas for both categorical data and trend (P for trend < 0.001, 0.009), but not body mass index (BMI). Among patients with BMI < 25, gallstone disease remained significantly associated with VAT area (P for trend 0.021) and SAT area (P for trend 0.005). Interactions between the obesity indices and being elderly on the risk of gallstone disease were found; specifically BMI (P = 0.005), SAT (P < 0.001), and VAT (P = 0.154). A significant association between all obesity indices and gallstone disease was seen in patients aged < 65 but not among those aged ≥ 65. However, no significant association was noted between the obesity indices and sex.
CT-measured adipose tissue, rather than BMI, was a better predictor for risk of gallstone disease. This finding applies to younger people or even those with normal body weight, suggesting the importance of abdominal visceral fat accumulation in the development of gallstone disease.
内脏型肥胖是胰岛素抵抗的一个重要决定因素，胰岛素抵抗会降低胆囊收缩素反应敏感性，并增加胆囊胆汁中的胆固醇饱和度；因此，它可能与胆结石疾病的发生有关。我们旨在研究通过计算机断层扫描（CT）测量的内脏脂肪是否是胆结石疾病的危险因素。
对717名接受CT和超声检查的参与者进行了队列分析。分析了体重指数（BMI）、内脏脂肪组织（VAT）面积、皮下脂肪组织（SAT）面积与胆结石疾病之间的关联，并对年龄、性别、高血压、糖尿病和血脂异常进行了校正。
在多变量分析中，对于分类数据和趋势分析，胆结石疾病与VAT和SAT面积均显著相关（趋势P值<0.001，0.009），但与体重指数（BMI）无关。在BMI<25的患者中，胆结石疾病仍与VAT面积（趋势P值0.021）和SAT面积（趋势P值0.005）显著相关。发现肥胖指数与老年人患胆结石疾病风险之间存在相互作用；具体为BMI（P=0.005）、SAT（P<0.001）和VAT（P=0.154）。在年龄<65岁的患者中，所有肥胖指数与胆结石疾病之间均存在显著关联，但在年龄≥65岁的患者中未观察到这种关联。然而，未发现肥胖指数与性别之间存在显著关联。
CT测量的脂肪组织而非BMI是胆结石疾病风险的更好预测指标。这一发现适用于年轻人甚至体重正常的人，提示腹部内脏脂肪堆积在胆结石疾病发生中的重要性。
