Kaiser Permanente study finds obese youth have significantly higher risk of gallstones
Children who are overweight or obese face an increased risk for gallstones, according to a Kaiser Permanente study published in the Journal of Pediatric Gastroenterology & Nutrition.
Researchers found that children and adolescents who were overweight were twice as likely to have gallstone disease, compared to children and adolescents who had a normal body mass index. Those who were moderately obese were four times as likely to have gallstones and those who were extremely obese were six times as likely to have gallstones.
The study was based on information in the electronic health records of more than 510,000 children ages 10 to 19, from 2007 through 2009, who were members of Kaiser Permanente Southern California.
The size and diversity of this population-based study allowed researchers to explore racial and ethnic disparities. Hispanic youth were more likely to have gallstones than youth of other races and ethnicities.
“Although gallstones are relatively common in obese adults, gallstones in children and adolescents have been historically rare,” said study lead author Corinna Koebnick, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. “These findings add to an alarming trend-youth who are obese or extremely obese are more likely to have diseases we normally think of as adult conditions.”
Researchers found a stronger association between obesity and gallstones in girls than in boys. Girls who were obese and extremely obese were six and eight times more likely, respectively, to have gallstones than girls who were underweight or of normal weight, while obese and severely obese boys were more than twice and three times as likely to have gallstones as their normal or underweight counterparts.
Gallstone disease is a major health problem in the United States, affecting an estimated 20 million adults. Symptoms of gallstones include recurrent abdominal pain and nausea, although many people with gallstones have no symptoms. Gallstones can block the passage of bile into the intestine, which in turn can cause severe damage or infection in the gallbladder, liver, or pancreas and, if left untreated, the condition can be fatal.
How Are Gallstones Linked to Obesity?
Obese individuals are more likely to develop gallstones than those who are at a healthier weight. For women, obesity is an even stronger risk factor for developing gallstones. Researchers have found that obese individuals tend to produce higher levels of cholesterol than normal. This leads to production of bile that contains more cholesterol than can be dissolved. When this happens, gallstones can form from the undissolved cholesterol.
Additionally, in the obese, gallbladders may not empty normally or completely.
Research has shown that those who have excess fat around their stomach (abdominal obesity) may be at a greater risk for developing gallstones than those who carry excess fat mainly around their hip and thigh areas.
As BMI increases, the risk for developing gallstones also rises. Women with a BMI greater than 32 may be as much as three times as likely to develop gallstones as those with a BMI of 24 or 25. The risk may be seven times higher in women with a BMI above 45 than in those with a BMI under 24.
It’s important to note that rapid weight loss (more than three pounds per week) due to crash dieting or losing a large amount of weight too soon can actually increase your chances of developing gallstones, too. Slower weight loss of about one-half to two pounds a week is much less likely to cause gallstones.
Although losing weight may increase the risk of developing gallstones, obesity poses an even greater risk. Weight loss can lower the risk of developing gallstones and many other obesity-related illnesses. Just a 10% reduction of body weight can lower disease risk. Losing 10% of your current weight over the next six months is a realistic goal that can significantly improve your life and your overall health.
“The high rate of gallstones in obese children and adolescents may surprise pediatricians because gallstone disease is generally regarded as an adult disorder. Since obesity is so common, pediatricians must learn to recognize the characteristic symptoms of gallstones,” said George Longstreth, MD, senior study author and a gastroenterologist from Kaiser Permanente San Diego Medical Center.
“With increasing numbers of cases of gallstones in children, we wanted to better understand the potential role of risk factors such as obesity, gender, ethnicity, and oral contraceptive use,” added Koebnick. “With childhood obesity on the rise, pediatricians can expect to diagnose and treat an increasing number of children affected by gallstone disease. It is important to identify other factors that increase risk as well.”
Risk of symptomatic gallstones in women with severe obesity
Although obesity is a well-recognized risk factor for gallstones, the excess risks associated with higher levels of obesity and recent weight change are poorly quantified. We evaluated these issues in the Nurses’ Health Study. Among 90,302 women aged 34-59 y at baseline followed from 1980 to 1988, 2122 cases of newly diagnosed symptomatic gallstones occurred during 607,104 person-years of follow-up. From 1980 to 1986, 488 cases of newly diagnosed unremoved gallstones were documented. We observed a striking monotonic increase in gallstone disease risk with obesity; women with a body mass index (BMI) greater than 45 kg/m2 had a sevenfold excess risk compared with those whose BMI was less than 24 kg/m2. Women with a BMI greater than 30 kg/m2 had a yearly gallstone incidence of greater than 1% and those with a BMI greater than or equal to 45 kg/m2 had a rate of approximately 2%/y. Recent weight loss was associated with a modestly increased risk after adjustment for BMI before weight loss. Current smoking was an independent risk factor; women smoking greater than or equal to 35 cigarettes/d had a relative risk of 1.5 (95% CI 1.2-1.9).
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M J Stampfer, K M Maclure, G A Colditz, J E Manson, and W C Willett
The American Journal of Clinical Nutrition
This study is part of ongoing research and community programs that aim to identify and treat childhood obesity. The Kaiser Permanente Southern California Children’s Health Study found that 7.3 percent of boys and 5.5 percent of girls under the age of 20 years are extremely obese.
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This study was funded by the National Institute of Diabetes and Digestive and Kidney Disorders.
Other study authors included Ning Smith, PhD, Mary Helen Black, PhD, Sharon Hudson, PhD, Steven J Jacobsen, MD, PhD, of the Department of Research & Evaluation, Kaiser Permanente Southern California; Amy H Porter, MD, of the Kaiser Permanente Los Angeles Medical Center; Bradley A Richie, MD, of the Kaiser Permanente Riverside Medical Center; and Deborah Gililland, DO, of the Kaiser Permanente Fontana Medical Center.
About the Kaiser Permanente Southern California Department of Research & Evaluation
The Department of Research & Evaluation (R & E) conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population.
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Catherine Hylas Saunders
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202-585-2603
Kaiser Permanente