Dietary patterns, lifestyle factors and their association with the incidence of cholelithiasis in adults: A systematic review
DOI:
https://doi.org/10.5281/zenodo.18176908Keywords:
cholelithiasis, incidence, diabetes mellitus, type 2, lifestyle, systematic reviewAbstract
Objective: To identify and synthesize the available evidence from prospective studies on the association between lifestyle factors and metabolic phenotypes (specifically type 2 diabetes mellitus [T2DM]) and the incidence of objectively diagnosed cholelithiasis in adults.
Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Searches were performed in PubMed/MEDLINE, Embase and CENTRAL. Prospective cohort studies evaluating the association between lifestyle or metabolic factors and the incidence of cholelithiasis confirmed by objective methods (imaging or coded medical records) were included, explicitly excluding self-report to avoid detection bias.
Results: Of 238 records identified, a single high-quality cohort study was included (UK Biobank, n=383,283). This study showed that T2DM, acting as a phenotypic marker of chronic metabolic exposure, is significantly associated with an increased incidence of cholelithiasis (adjusted hazard ratio [HR] = 1.39; 95% CI: 1.29–1.50; P < 0.001). Mendelian randomization analyses confirmed a causal relationship (OR = 1.08).
Conclusions: There is a critical gap in the prospective literature that uses objective diagnoses to evaluate specific nutritional factors. Current evidence robustly confirms that the diabetic metabolic phenotype increases the risk of lithogenesis, suggesting that primary prevention should focus on correcting insulin resistance.
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References
Stinton LM, Shaffer EA. Epidemiology of gallstone disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87.
Afdhal NH. Gallstones and biliary tract disease. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia: Elsevier; 2021. chap 65.
Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri V, Wang DQ. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol. 2016;10(1):93-112.
Biddinger SB, Haas JT, Yu BB, Bezy O, Jing E, Zhang W, et al. Hepatic insulin resistance directly promotes formation of cholesterol gallstones. Nat Med. 2008;14(7):778-82.
Wang K, Liu Z, Tang R, Sha Y, Wang Z, Chen Y, et al. Gallstones in the Era of Metabolic Syndrome: Pathophysiology, Risk Prediction, and Management. Cureus. 2025;17(1):e80541.
Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007;52(5):1313-25.
Attili AF, Pazzi P, Galeazzi R. Prevalence of previously undiagnosed gallstones in a population with multiple risk factors. Dig Dis Sci. 1995;40(8):1770-4.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Ottawa: Ottawa Hospital Research Institute; 2021. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Yan P, Wang Y, Zhu Y, Li Y, Liu Y. Observational and genetic analyses clarify the relationship between type 2 diabetes mellitus and gallstone disease. Front Endocrinol (Lausanne). 2023;14:1337071.
Saha S, Mukherjee S, Banerjee A, Bhattacharyya S. Silent Gallbladder Stone Associated with Nonalcoholic Fatty Liver Disease in a Scenario of Insulin Resistance in Young Adults. Indian J Med Biochem. 2019;23(1):226–9.
Tehrani A, Saadati S, Yari Z, Salehpour A, Sadeghi A, Daftari G, et al. Dietary fiber intake and risk of gallstone: a case–control study. BMC Gastroenterol. 2023;23(1):275.
Zuo D, Sang M, Sun X, Chen G, Ji K. Inverse association between dietary fiber intake and gallstone disease in U.S. adults: a cross-sectional study from the NHANES database. Front Nutr. 2025;12:1624173.
Bai Y, Zhang M, Cui H, Shan X, Gu D, Wang Y, et al. Addictive behavior and incident gallstone disease: A dose–response meta-analysis and Mendelian randomization study. Front Nutr. 2022;9:940689.
Ishizuka H, Eguchi H, Oda T, Ogawa S, Nakagawa K, Honjo S, et al. Relation of coffee, green tea, and caffeine intake to gallstone disease in middle-aged Japanese men. Eur J Epidemiol. 2003;18(5):401-5.
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Copyright (c) 2026 Lauro Athanasio Schuck, Lucas Henrique Marczewski Idargo, Reinaldo Antônio Sobrinho da Silva, Felipe Grützmacher dos Santos, Lucas Eugenio Rodrigues Mendes, Luiz Guerra Neto, Raphaela Bringhenti Melo, Andrea Paola Britos Gómez (Autor/a)
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