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Body mass index, abdominal fatness and the risk of gallbladder disease

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Abstract

Epidemiological studies have indicated a positive association between adiposity and gallbladder disease risk, however, the shape of the dose–response relationship and differences between overall and abdominal adiposity remains to be clarified. We conducted a systematic review and dose–response meta-analysis of cohort studies of body mass index (BMI), waist circumference and waist-to-hip ratio and risk of gallbladder disease. PubMed and Embase databases were searched up to January 9th 2015. Summary relative risks were calculated using a random effects model. Seventeen prospective studies of BMI and gallbladder disease risk with 55,670 cases among 1,921,103 participants were included. The summary relative risk (RR) for a 5 unit increment in BMI was 1.63 (95 % CI 1.49–1.78, I2 = 98 %). There was evidence of a nonlinear association overall and among women, p nonlinearity < 0.0001, but not among men, p nonlinearity = 0.99, with a slight flattening of the curve at very high BMI levels (BMI 40–45), however, the risk of gallbladder disease increased almost twofold even within the “normal” BMI range. The summary RR for a 10 cm increase in waist circumference was 1.46 (95 % CI 1.24–1.72, I2 = 98 %, n = 5) and for a 0.1 unit increment in waist-to-hip ratio was 1.44 (95 % CI 1.26–1.64, I2 = 92 %, n = 4). Associations were attenuated, but still significant, when BMI and abdominal adiposity measures were mutually adjusted. Our results confirm a positive association between both general and abdominal fatness and the risk of gallbladder disease. There is an almost twofold increase in the risk even within the “normal” BMI range, suggesting that even moderate increases in BMI may increase risk.

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Acknowledgments

We thank Dr. Arthur Hartz for providing supplementary data from the Women’s Health Initiative. This work has been supported by funding from Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU). The study sponsor had no role in the study design, collection of data, analysis, and interpretation of data. The authors declare that there is no duality of interest associated with this manuscript. D. Aune takes primary responsibility for the integrity of the data and the accuracy of the data analysis. We thank Darren C. Greenwood (PhD, Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds) for the Stata code for the nonlinear dose–response analysis.

Contribution

DA, TN, LJV conceived of and designed the study. DA conducted the literature search and analyses and wrote the first draft of the paper. All authors interpreted the data, contributed to the draft of the paper, revised the subsequent drafts for important intellectual content, read and approved the final manuscript. D. Aune takes primary responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This work has been supported by funding by the “Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU). The funding source had no role in the study design, collection, analysis and interpretation of the data, in the writing of the report or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Dagfinn Aune & Lars J. Vatten

  2. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, Paddington, London, W2 1PG, UK

    Dagfinn Aune & Teresa Norat

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  1. Dagfinn Aune
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Correspondence to Dagfinn Aune.

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Aune, D., Norat, T. & Vatten, L.J. Body mass index, abdominal fatness and the risk of gallbladder disease. Eur J Epidemiol 30, 1009–1019 (2015). https://doi.org/10.1007/s10654-015-0081-y

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