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168饮食习惯，是否增加胆囊结石结石风险
胆囊结石（或胆石症）是一种常见的健康问题，影响着大量成年人，尤其在西方国家，其发生率更高。众多研究已经探讨了饮食习惯与胆石形成之间的关系，结果表明某些饮食模式和特定食品的摄入确实会增加胆囊结石的风险。
1. 胆囊结石的形成机制
胆囊结石主要由胆固醇或胆色素组成，形成原因与多种因素相关，包括遗传因素、生活方式及饮食习惯。例如，肥胖、饮食中高糖、高脂肪、低纤维的食物都被认为是促进胆石形成的重要因素.在膳食结构方面，快速食品、高果糖饮料及含有大量精制糖和脂肪的高热量饮食尤其危险，这些饮食形式会导致胆固醇代谢的异常，从而促进胆石生成。
2. 危险性饮食模式
一些特定的饮食模式与胆囊结石风险的增加相关，包括：
- 超加工食品的消费：研究表明，日常食用超加工食品（如含添加糖的饮料、快餐等）与胆囊结石风险之间存在明显关联。高摄入量的超加工食品与胆囊结石的发生率正相关。
- 高热量和高糖分饮食：高能量摄入，尤其是富含精制糖及低纤维食物的饮食，会导致激素水平变化和胆固醇代谢紊乱，这都增加了胆囊结石的风险。
3. 保护性饮食因素
与上述危险因素相对，某些饮食习惯被认为有助于保护人们免受胆囊结石的影响。例如：
- 增加果蔬摄入：研究发现，增加水果和蔬菜的摄入量对降低胆石风险有显著作用，即每增加200克蔬菜或水果的摄入，胆石风险会分别减少4%和3%。这与其富含纤维和抗氧化成分的特性有关。
- 健康脂肪的摄入：富含单不饱和脂肪（如橄榄油和坚果）的饮食显示出保护作用，可以降低胆囊结石的形成风险。
4. 评价饮食炎症指数（DII）
另一个与胆囊结石相关的饮食评估工具是饮食炎症指数（DII）。许多研究显示，DII更高的人群相比于DII较低的人群，胆囊结石的发病风险显著更高。在超重或肥胖人群中，这种关系尤为明显。
5. 基于植物的饮食和胆石风险
植物性饮食，特别是富含蔬菜、全谷物及低饱和脂肪的饮食，被发现与较低的胆囊结石风险相关。如一些研究显示，素食者的胆石发生率低于食肉者，部分原因可能与其较低的血脂水平有关。
6. 饮食推荐
针对胆囊结石的预防，以下饮食建议值得考虑：
- 增加纤维摄入：多吃绿色蔬菜、水果、豆类和全谷物，以提高膳食纤维的摄入。
- 选择健康脂肪：选择橄榄油、坚果等单不饱和脂肪，而减少饱和脂肪和反式脂肪的摄入。
- 减少糖分和超加工食品：限制糖分的摄入，避免高热量的快餐和含糖饮料。
- 注意适量饮酒：适度饮酒可能与胆石风险降低相关，需注意个体差异【】。
7. 总结
综上，饮食习惯不仅直接影响胆囊结石的形成风险，也通过改变身体的代谢与激素水平等间接影响胆囊的健康。因此，调整饮食结构，尤其是增加健康食品的摄入和减少不健康食品的消费，是降低胆囊结石发生风险的有效策略。未来的研究应进一步探索不同饮食成分的具体影响及机制，以便提出更加精准的预防方法。
References
1The Role of Diet in the Pathogenesis of Cholesterol Gallstones.PubMed译饮食在胆固醇结石发病机制中的作用。
et al.
Cholesterol gallstone disease is a major health problem in Westernized countries and depends on a complex interplay between genetic factors, lifestyle and diet, acting on specific pathogenic mechanisms. Overweigh, obesity, dyslipidemia, insulin resistance and altered cholesterol homeostasis have been linked to increased gallstone occurrence, and several studies point to a number of specific nutrients as risk- or protective factors with respect to gallstone formation in humans. There is a rising interest in the identification of common and modifiable dietetic factors that put the patients at risk of gallstones or that are able to prevent gallstone formation and growth. In particular, dietary models characterized by increased energy intake with highly refined sugars and sweet foods, high fructose intake, low fiber contents, high fat, consumption of fast food and low vitamin C intake increase the risk of gallstone formation. On the other hand, high intake of monounsaturated fats and fiber, olive oil and fish (ω-3 fatty acids) consumption, vegetable protein intake, fruit, coffee, moderate alcohol consumption and vitamin C supplementation exert a protective role. The effect of some confounding factors (e.g., physical activity) cannot be ruled out, but general recommendations about the multiple beneficial effects of diet on cholesterol gallstones must be kept in mind, in particular in groups at high risk of gallstone formation.
2Gallstones: Prevention, Diagnosis, and Treatment.PubMed译胆石症：预防、诊断与治疗。
Semin Liver Dis. 2024 Aug;44(3):394-404. doi: 10.1055/a-2378-9025. Epub 2024 Aug 2.
Gallstones are common and affect up to 20% of the general adult population and >20% of them will develop symptoms or complications of cholelithiasis. The high risk of gallbladder stone formation can be reduced by ursodeoxycholic acid in the case of significant weight reduction resulting from diet or bariatric surgery. Laparoscopic cholecystectomy is indicated for symptomatic gallstones, as the risk of recurrence or complications increases over the course of the disease. Biliary colic is treated with nonsteroidal anti-inflammatory drugs and spasmolytics; opioids can also be used in cases of severe acute pain. Acute cholecystitis represents a common complication of gallbladder stones and a cholecystectomy should be performed early electively, i.e., within 24 hours of admission to hospital. Symptomatic bile duct stones are primarily treated endoscopically. Immediate anti-infective therapy is mandatory in acute cholangitis. Although knowledge on the genetics and pathophysiology of gallstones has increased, current treatment algorithms remain predominantly invasive, based on interventional endoscopy and surgery. Future efforts should focus on novel strategies to prevent the development of gallstones.
3Obesity and Gallstones.PubMed
Nela Melissa Parra-Landazury, Jacqueline Cordova-Gallardo, Nahum Méndez-Sánchez
Visc Med. 2021 Oct;37(5):394-402. doi: 10.1159/000515545. Epub 2021 Apr 23.
BACKGROUND: The prevalence of obesity has been increasing globally and represents the main risk factor for the development of gallstone disease (GD). SUMMARY: Excess body weight represents the main cause for the development of GD; nevertheless, there have been described multiple risk factors for its development, among them modifiable risk factors as diet, lifestyle, physical inactivity, and non-modifiable risk factors as ethnicity, female sex, advanced age, parity, and genetic mutations. Body mass index, abdominal perimeter, and waist-hip index have been used to determine the degree of adiposity of a person. Hence, central abdominal fat has been mostly associated with insulin resistance with the consequent increase in the hepatic cholesterol secretion; contributing as one of the multiple mechanisms associated with the development of gallstones. This disease has a low mortality; however, it has been associated with multiple diseases such as cardiovascular diseases, carotid atherosclerosis, metabolic associated fatty liver disease, and gallbladder cancer, probably because they share many of the risk factors. KEY MESSAGES: GD continues to be considered a disease with a high medical burden, in which it is sought to intervene in modifiable risk factors to reduce its development.
4Association between dietary inflammatory index and gallstones in US adults.PubMed
Yanling Luo, Xiaolian Gao, Mingzhong Xiao, et al.
Front Nutr. 2024 May 3;11:1403438. doi: 10.3389/fnut.2024.1403438. eCollection 2024.
INTRODUCTION: Previous studies have found that diet's inflammatory potential is related to various diseases. However, little is known about its relationship with gallstones. The present study aims to investigate the relationship between dietary inflammatory index (DII) and gallstones. METHODS: Data were obtained from the 2003-2020 National Health and Nutrition Examination Survey (NHANES). We used the nearest neighbor propensity score matching (PSM) with a ratio of 1:1 to reduce selection bias. Logistic regression models estimated the association between DII and gallstones. The non-linear relationship was explored with restricted cubic splines (RCS). BMI subgroup stratification was performed to explore further the connection between DII and gallstones in different populations. RESULTS: 10,779 participants were included. Before and after PSM, gallstone group individuals had higher DII scores than non-gallstone group individuals ( < 0.05). Matched logistic regression analysis showed that DII scores were positively correlated with gallstone risk (adjusted OR = 1.14, 95% CI 1.01, 1.29). The stratified analysis showed that this association was stronger in overweight or obese people (adjusted OR = 1.18, 95% CI 1.03, 1.34). RCS analysis suggested that DII and gallstones showed a "J"-shaped non-linear dose-response relationship ( non-linear <0.001). CONCLUSION: Higher DII score is positively associated with the risk of gallstones, particularly in overweight or obese population, and this relationship is a "J"-shaped non-linear relationship. These results further support that avoiding or reducing a pro-inflammatory diet can be an intervention strategy for gallstone management, particularly in the overweight or obese population.
5Recent advances in understanding and managing cholesterol gallstones.PubMed
Agostino Di Ciaula, Piero Portincasa
F1000Res. 2018 Sep 24;7. doi: 10.12688/f1000research.15505.1. eCollection 2018.
The high prevalence of cholesterol gallstones, the availability of new information about pathogenesis, and the relevant health costs due to the management of cholelithiasis in both children and adults contribute to a growing interest in this disease. From an epidemiologic point of view, the risk of gallstones has been associated with higher risk of incident ischemic heart disease, total mortality, and disease-specific mortality (including cancer) independently from the presence of traditional risk factors such as body weight, lifestyle, diabetes, and dyslipidemia. This evidence points to the existence of complex pathogenic pathways linking the occurrence of gallstones to altered systemic homeostasis involving multiple organs and dynamics. In fact, the formation of gallstones is secondary to local factors strictly dependent on the gallbladder (that is, impaired smooth muscle function, wall inflammation, and intraluminal mucin accumulation) and bile (that is, supersaturation in cholesterol and precipitation of solid crystals) but also to "extra-gallbladder" features such as gene polymorphism, epigenetic factors, expression and activity of nuclear receptors, hormonal factors (in particular, insulin resistance), multi-level alterations in cholesterol metabolism, altered intestinal motility, and variations in gut microbiota. Of note, the majority of these factors are potentially manageable. Thus, cholelithiasis appears as the expression of systemic unbalances that, besides the classic therapeutic approaches to patients with clinical evidence of symptomatic disease or complications (surgery and, in a small subgroup of subjects, oral litholysis with bile acids), could be managed with tools oriented to primary prevention (changes in diet and lifestyle and pharmacologic prevention in subgroups at high risk), and there could be relevant implications in reducing both prevalence and health costs.
6Association between plant-based dietary index and gallstone disease: A cross sectional study from NHANES.PubMed译基于植物的饮食指数与胆囊疾病的关联：来自 NHANES 的横断面研究。
et al.
PLoS One. 2024 Jun 25;19(6):e0305822. doi: 10.1371/journal.pone.0305822. eCollection 2024.
BACKGROUND: The relationship between plant-based diets and gallstone disease has been debated. This study aimed to shed light on the association between plant-based dietary index and the risk of developing gallstone disease. METHODS: Eligible participants were selected from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Three plant-based diet indexes (PDI, healthy PDI, unhealthy PDI) were calculated using data from two NHANES 24-h dietary recall interviews. Restricted Cubic Spline and multivariate logistic regression were used to analyze the associations. Subgroup analysis was adopted to make the results more robust. RESULTS: A total of 5673 eligible participants were analyzed. After adjusting for various confounding variables, uPDI was positively associated with gallstone disease (OR = 1.53, 95%CI: 1.02-2.29). No association was found between PDI/hPDI and gallstone disease (p > 0.05). The results of subgroup analysis did not show any positive association between uPDI and gallstones in specific groups. CONCLUSION: Our study shows that the elevated uPDI are linked to a higher risk of gallstone disease.
7Excess Body Weight and Gallstone Disease.PubMed
Caroline Sarah Stokes, Frank Lammert
Visc Med. 2021 Aug;37(4):254-260. doi: 10.1159/000516418. Epub 2021 Jun 15.
BACKGROUND: Approximately one fifth of adults are diagnosed with gallstones worldwide. Of these, around 25% develop gallstone disease (indicated by the presence of symptoms) and undergo cholecystectomy. SUMMARY: The risk of gallstones is influenced by a combination of genetic and lifestyle factors, such as excess body weight. In fact, body mass has been demonstrated to be a major risk factor for symptomatic gallstones. Rapid weight loss can also initiate a prolithogenic state and further increase the likelihood of either gallstone formation or existing gallstones becoming symptomatic; however, sensible weight loss strategies can mitigate this risk. This review discusses the role of excess body weight and the risk of gallstone disease, as well as the options available for the prevention of symptomatic gallstones. KEY MESSAGES: Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones. Should rapid weight loss be required for health reasons or be expected, e.g., after bariatric surgery, prophylactic ursodeoxycholic acid during the period of weight reduction has been demonstrated to reduce the incidence of gallstones formation or symptomatic gallstone occurrence. The recent German guidelines on gallstones recommend simultaneous cholecystectomy during bariatric surgery but only for those with preexisting symptomatic stones.
8Fruits and vegetables consumption and the risk of gallstone diasease: A systematic review and meta-analysis.PubMed
Jun-Wei Zhang, Jian-Ping Xiong, Wei-Yu Xu, et al.
Medicine (Baltimore). 2019 Jul;98(28):e16404. doi: 10.1097/MD.0000000000016404.
BACKGROUND: The role of fruit and vegetables (FVs) consumption in decreasing gallstone disease risk remains contradictory. We performed a meta-analysis to analyze this potential correlation, followed by investigation of dose-response relationship of FVs consumption with gallstone disease. MATERIALS AND METHODS: PubMed, Embase, as well as Web of Science were searched to determine all published researches about the connection of FVs consumption with gallstone disease before March 2018. Relative risks (RRs) or odds ratios (ORs) along with corresponding 95% confidence intervals (CIs) was pooled utilizing random effect models, aiming at examining the correlation of FVs consumption with gallstone disease risk. RESULTS: One cross-sectional study, our case-control studies as well as nine cohort studies were enrolled, covering approximately 33,983 patients with gallstone disease and 1,53,3752 participants. In a pooled analysis, vegetables consumption was significantly related to a decreased gallstone disease risk, (RR = 0.83, 95% CI, 0.74-0.94, I = 91.1%), and for fruits consumption, RR was similar (RR = 0.88, 95%CI, 0.83-0.92, I = 0.01%). This inverse correlation of FVs consumption with gallstone disease risk was solid in most subgroup analysis. The nonlinear dose-response correlation indicated that gallstone risk was reduced by 4% (RR = 0.96, 95%CI, 0.93-0.98) and 3% (RR = 0.97, 95%CI, 0.96-0.98) for every 200 g per day increment in vegetables consumption (P = .001) and fruits consumption (P = .001), respectively. CONCLUSION: This study suggests vegetables and fruits consumption is correlated with a significantly reduced risk of gallstone disease.
9Association of dietary quality indicators with gallstones in the US: NHANES 2017-2020.PubMed
Weigen Wu, Yuchen Pei, Junlong Wang, et al.
BMC Public Health. 2025 Mar 12;25(1):976. doi: 10.1186/s12889-025-21783-8.
BACKGROUND: While dietary factors are known to influence gallstone development, the specific relationships between comprehensive dietary quality indicators and gallstone risk remain poorly understood. This study aimed to explore the association between dietary quality indicators and gallstones using data from the 2017 to 2020 US National Health and Nutrition Examination Survey (NHANES). METHODS: A total of 6,623 US adults were extracted from the 2017-2020 NHANES, of which 734 participants self-reported having gallstones. Dietary quality indicators were assessed using 24-hour dietary recall data. We used multivariate logistic regression analysis to evaluate the association between dietary quality indicators and the likelihood of gallstones. To delineate the non-linear relationships and threshold effects, we utilized a restricted cubic spline (RCS) regression model. Subgroup analyses were also performed. RESULTS: After adjusting for sex, age, race, education, poverty-to-income ratio, body mass index, large weight loss, alcohol use, smoking, physical activity, diabetes, hypertension, heart failure, coronary heart disease, angina pectoris, heart attack, total calories, total cholesterol, estrogen use, antihyperglycemic drug use, statin use, and glucocorticosteroid use (Model 4), a higher Dietary Inflammatory Index (DII) and lower Alternative Healthy Eating Index (AHEI), Healthy Eating Index (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MED) were all significantly associated with gallstones. Further RCS analysis revealed a nonlinear relationship between the DII and gallstones, with a threshold value of 1.842. Above this threshold, for each unit increase in the DII score, the odds of developing gallstones increased by 27.5%. Subgroup analysis demonstrated that this association was consistent across all subgroups. CONCLUSION: Participants with gallstones exhibited poor dietary habits. Adopting a diet that reduces inflammation and supports overall health may help lower the risk of gallstone development, with potential implications for dietary recommendations in clinical practice.
10Mendelian randomization study on the causal relationship between food and cholelithiasis.PubMed
Zhicheng Liu, Shun Liu, Peizhe Song, et al.
Front Nutr. 2024 Mar 4;11:1276497. doi: 10.3389/fnut.2024.1276497. eCollection 2024.
BACKGROUND: Cholelithiasis, commonly referred to as gallstones, is a prevalent medical condition influenced by a combination of genetic factors, lifestyle choices, and dietary habits. Specific food items have been associated with an increased susceptibility to cholelithiasis, whereas others seem to offer a protective effect against its development. METHODS: In this study, we conducted a Mendelian randomization (MR) analysis using a large-scale genetic dataset comprising individuals with European ancestry to explore the potential causal relationship between diet and cholelithiasis. The analysis incorporated 17 food-related variables, which were considered as potential factors influencing the occurrence of this condition. RESULTS: Our findings indicate that a higher consumption of cooked vegetables, dried fruit, and oily fish is associated with a reduced risk of cholelithiasis. Conversely, a higher consumption of lamb is associated with an increased risk of developing the condition. Importantly, these associations proved robust to sensitivity and heterogeneity tests, and the pleiotropic test results further supported the hypothesis of a causal relationship between diet and cholelithiasis. CONCLUSION: Through our study, we provide compelling evidence for the existence of a causal relationship between diet and cholelithiasis. Adopting a dietary pattern enriched with cooked vegetables, dried fruit, and oily fish, while minimizing lamb intake, may contribute to the prevention of cholelithiasis. Recognizing diet as a modifiable risk factor in the prevention and management of this condition is of paramount importance, and our study offers valuable insights in this regard.
11Association of pro-inflammatory diet with increased risk of gallstone disease: a cross-sectional study of NHANES January 2017-March 2020.PubMed
Jinnian Cheng, Qian Zhuang, Weiyi Wang, et al.
Front Nutr. 2024 Mar 14;11:1344699. doi: 10.3389/fnut.2024.1344699. eCollection 2024.
BACKGROUND AND AIM: Gallstone disease (GSD) is a major public health problem worldwide. The dietary inflammatory index (DII) and the energy-adjusted DII (E-DII) have been used to describe dietary inflammatory potential. The current study sought to investigate the pro-inflammatory role of diet on GSD among outpatients in the United States. METHODS: Cross-sectional data from 7,334 individuals older than 20 years who participated in the National Health and Nutrition Examination Survey (NHANES) from January 2017 to March 2020 were obtained. The relationship between GSD and DII was assessed using self-reported data. An association between DII and the risk of GSD was determined using sample-weighted logistic regression and restricted cubic splines (RCS). Subgroup analyzes were conducted to assess the interaction between DII and related factors. Sensitivity analysis was further used to confirm the stability of the relationship. To control for the effect of total energy intake, E-DII was calculated and analyzed. RESULTS: A total of 10.5% of the study participants had GSD. The DII ranged from -5.52 to 5.51, and the median DII was significantly higher for participants with GSD than those without (1.68 vs. 1.23, < 0.001). There was a significant and stable positive relationship between DII and GSD in adjusted models (OR 1.10, 95% CI 1.00-1.20). In the fully adjusted model, subjects with DII scores in the highest tertile were more likely to have GSD than those in the lowest tertile (OR 1.52, 95% CI 1.19-1.93). An apparent dose-response association between DII and GSD was detected. The association between E-DII and GSD remained stable. CONCLUSION: Higher DII/E-DII scores linked to the intake of a pro-inflammatory diet were positively associated with a higher risk of GSD. These findings suggest that pro-inflammatory dietary patterns can promote the formation of gallstones.
12Magnesium: does a mineral prevent gallstones?PubMed
Cynthia W Ko
Am J Gastroenterol. 2008 Feb;103(2):383-5. doi: 10.1111/j.1572-0241.2007.01690.x.
Gallstone-related disorders are common and costly, but preventive measures are largely unexplored. Lifestyle risk factors include physical activity, obesity/overweight, and diet. Increasing consumption of magnesium appears to decrease the risk of symptomatic gallstones in men, although the underlying mechanisms remain unclear. Understanding the role of a healthy diet in gallstone-related diseases, including a diet high in magnesium, may lead to new preventive measures.
13Ultraprocessed food consumption and risk of gallstone disease: analysis of 3 prospective cohorts.PubMed译超加工食品的消费与胆囊疾病风险：3 项前瞻性队列研究的分析。
et al.
BACKGROUND: Majority of dietary intake in United States adults comes from ultraprocessed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the United States health system but remains understudied. OBJECTIVES: This study aimed to investigate the association between UPF consumption and incident gallstone disease risk. METHODS: In this analysis, 44,149 males in the Health Professionals' Follow-up Study (HPFS: 1986-2022), 71,145 females in the Nurses' Health Study (NHS: 1986-2021), and 90,932 females in the NHS II (1991-2021) were prospectively followed. Dietary intake was quadrennially assessed with semiquantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: Baseline median age was 54 y in HPFS, 53 y in NHS, and 36 y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease than those in the lowest quintile (aHR: 1.29; 95% CI: 1.24, 1.36; P < 0.001). Incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%, 3.2%; P < 0.001). This risk was driven by sugar-sweetened beverages and artificially sweetened beverages on UPF subgroup analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%, 20.5%; P < 0.001) in HPFS, 14.3% (95% CI: 10.4%, 19.4%; P < 0.001) in NHS, and 39.4% (95% CI: 31.2%, 48.1%; P < 0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%, 18.3%). CONCLUSIONS: UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.
14The role of diet and nutrition related indicators in biliary diseases: an umbrella review of systematic review and meta-analysis.PubMed
Yaoqun Wang, Jiong Lu, Ningyuan Wen, et al.
Nutr Metab (Lond). 2022 Jul 30;19(1):51. doi: 10.1186/s12986-022-00677-1.
BACKGROUND: Diet and nutrition, as a modifiable risk factor, have been demonstrated to play a significant role in the etiology of biliary diseases, whereas few comprehensive studies have been able to evaluate the strength and quality of these evidence. This umbrella review aims to evaluate the evidence pertaining risk factors for biliary diseases in terms of diet and nutrition-related indicators. METHODS: An umbrella review method was adopted: evidence from observational studies up to 22 November 2021 were identified using PubMed, Web of Science, the Cochrane database, as well as manual screening. Eligible systematic reviews and meta-analyses were screened according to inclusion and exclusion criteria. The inclusion criteria were: (1) meta analysis or systematic review; (2) The theme of the study is the relationship between diet or nutrition and biliary tract diseases; (3) Summarized and reported OR, RR or HR values and corresponding 95% CI; (4) No restrictions on the use of participants and languages; (5) Only extract the data of biliary tract diseases from multiple health outcomes; (6) Only the most recent studies on the same subject were included. This study had been registered at PROSPERO (CRD42021293908). For each eligible systematic review and meta-analysis, we extracted the data of general characteristics and the main findings. The methodological quality of the meta-analyses included in our study were assessed by AMSTAR2 and the quality of evidence was evaluated by the GRADE. RESULTS: A total of 323 articles were searched, among which 24 articles with 83 unique outcomes were identified as eligible. 35 of these outcomes were downgraded in GRADE evaluation as they reported heterogeneity. In short, among 83 unique outcomes, 5 were rated as moderate, 16 as low, and the rest as very low. For the prevention of biliary tract diseases, emphasis should be placed on appropriately increasing the intake of fruits, vegetables, coffee and tea, and reducing the intake of alcohol, raw fish and foods with high nitrate. Meanwhile, weight, blood sugar and lipid levels should be controlled, and diabetes should be actively prevented and treated. Drinking is not recommended to prevent gallstones, although studies have shown that it may reduce the risk of cholecystolithiasis. CONCLUSIONS: Our study summarizes the current multifaceted evidence on the relationship between dietary and nutritional indicators and biliary diseases, but the quality of all evidence was not high. Evidence from additional high-quality prospective studies are needed in the future.
15Diet and Risk of Cholecystectomy: A Prospective Study Based on the French E3N Cohort.PubMed
Amélie Barré, Gaëlle Gusto, Claire Cadeau, et al.
Am J Gastroenterol. 2017 Sep;112(9):1448-1456. doi: 10.1038/ajg.2017.216. Epub 2017 Jul 25.
OBJECTIVES: This study aimed to examine the relationship between diet and cholecystectomy risk, using three approaches, in a large French cohort. METHODS: In a prospective cohort study in French women who completed a food-frequency questionnaire at baseline, we analyzed diet with three approaches: food groups, dietary patterns obtained by factor analysis, and the Mediterranean diet score. The primary outcome was cholecystectomy. We used Cox proportional hazards regression to assess the relationship between diet and cholecystectomy risk, adjusting for the main potential confounders. RESULTS: During 1,033,955 person years of follow-up, we identified 2,778 incident cases of cholecystectomy. Higher intakes of legumes, fruit, vegetable oil, and wholemeal bread were associated with decreased cholecystectomy risk. Two dietary patterns were identified by factor analysis: "Western" (essentially processed meat, pizza, pies, high-alcohol beverages, French fries, sandwiches…) and "Mediterranean" (essentially fruits, vegetables, seafood, and olive oil). The "Mediterranean" pattern was inversely associated with cholecystectomy risk in the subgroup of postmenopausal women who ever used menopausal hormone therapy (hazard ratio for quartile 4 vs. 1=0.79, 95% confidence interval (CI): 0.65-0.95; P for linear trend=0.008). High adherence to the Mediterranean diet was associated with decreased risk of cholecystectomy (hazard ratio for a 6-9 score vs. 0-3=0.89, 95% CI: 0.80-0.99; P for linear trend=0.02). CONCLUSIONS: Adherence to a diet rich in fruit, vegetables, legumes, and olive oil was associated with a reduction in cholecystectomy risk in French women. Further studies in different settings are requested.
16Plant-Based Diet, Cholesterol, and Risk of Gallstone Disease: A Prospective Study.PubMed译植物性饮食、胆固醇与胆囊疾病风险：一项前瞻性研究。
et al.
Vegetarian diets may lower symptomatic gallstone disease via cholesterol lowering. This study aimed to examine the risk of symptomatic gallstone disease (GSD) in Taiwanese vegetarians vs. nonvegetarians in a prospective cohort and to explore if this association is related to cholesterol concentration. We prospectively followed 4839 participants, and in the 29,295 person-years of follow-up, 104 new incident GSD cases were confirmed. Diet was assessed through a validated food frequency questionnaire. Symptomatic GSD was ascertained through linkage to the Taiwan National Health Insurance Research Database. Blood cholesterol profiles were measured at recruitment. Cox regression was applied to assess the effect of diet on symptomatic GSD, adjusting for age, education, smoking, alcohol, physical activities, diabetes, kidney diseases, body mass index, lipid-lowering medication, and hypercholesterolemia. Vegetarian diet was associated with a decreased risk of symptomatic GSD compared with nonvegetarian diet in women (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28⁻0.96) but not in men. In women, nonvegetarians with hypercholesterolemia had 3.8 times the risk of GSD compared with vegetarians with normal cholesterol (HR, 3.81, 95% CI, 1.61⁻9.01). A vegetarian diet may therefore protect against GSD independent of baseline hypercholesterolemia. A nonvegetarian diet and hypercholesterolemia may have an additive effect in increasing GSD risk in women.
17Health aspects of vegetarian diets.PubMed
J T Dwyer
Am J Clin Nutr. 1988 Sep;48(3 Suppl):712-38. doi: 10.1093/ajcn/48.3.712.
Recent studies of vegetarian diets and their effects on morbidity and mortality are reviewed. Vegetarian diets are heterogeneous as are their effects on nutritional status, health, and longevity. Mortality rates are similar or lower for vegetarians than for nonvegetarians. Risks of dietary deficiency disease are increased on vegan but not on all vegetarian diets. Evidence for decreased risks for certain chronic degenerative diseases varies. Both vegetarian dietary and lifestyle practices are involved. Data are strong that vegetarians are at lesser risk for obesity, atonic constipation, lung cancer, and alcoholism. Evidence is good that risks for hypertension, coronary artery disease, type II diabetes, and gallstones are lower. Data are only fair to poor that risks of breast cancer, diverticular disease of the colon, colonic cancer, calcium kidney stones, osteoporosis, dental erosion, and dental caries are lower among vegetarians. Reduced risks for chronic degenerative diseases can also be achieved by manipulations of omnivorous diets and lifestyles.