Insulin Resistance and Incident Gallbladder Disease in Pregnancy

Overview

Journal Clin Gastroenterol Hepatol

Specialty Gastroenterology

Date 2007 Dec 11

PMID 18065273

Citations 11

Authors

Cynthia W Ko

Shirley A A Beresford

Scott J Schulte

Sum P Lee

Affiliations

Soon will be listed here.

Abstract

Background & Aims: Insulin resistance is associated with prevalent gallstones, but its effect on initial gallstone formation is not well-understood.

Methods: We conducted a nested case-control study to examine whether insulin resistance is a risk factor for initial gallbladder sludge and stone formation during pregnancy. Cases were 205 women with new gallbladder sludge and stones during pregnancy and the early postpartum. Controls were 443 randomly selected women without sludge or stones during pregnancy. Gallbladder ultrasounds were obtained during each trimester and at 4-6 weeks post partum. Fasting serum glucose, lipids, and insulin were measured at 26-28 weeks gestation. Insulin resistance was measured by the homeostasis model. Logistic regression was used to identify independent risk factors for gallstone formation.

Results: Insulin resistance was significantly greater in cases than in controls on univariate analysis (P < .001). Pre-pregnancy body mass index was strongly associated with gallstone formation on univariate analysis (P < .001), but this association was diminished after adjusting for insulin resistance (P = .01). On multivariate analysis, insulin resistance was significantly associated with gallstone formation (P = .004), even after adjustment for pre-pregnancy body mass index and other confounding factors including high-density lipoprotein cholesterol and physical activity. This association was strongest in women with pre-pregnancy body mass index <30 kg/m(2).

Conclusions: Insulin resistance is a risk factor for incident gallbladder sludge and stones during pregnancy, even after adjustment for body mass index. Insulin resistance might represent a causal link between obesity and overweight and gallstones.

Citing Articles

Higher relative fat mass was associated with a higher prevalence of gallstones in US adults.

Xie S, Ma S, Chen X, Fang L, Li D BMC Gastroenterol. 2025; 25(1):133.

PMID: 40038608 PMC: 11881264. DOI: 10.1186/s12876-025-03715-3.

Presentation of a Rare Case of Acute Cholecystitis in the Last Trimester of Pregnancy Misdiagnosed As Acute Gastroenteritis: A Brief Review From Symptoms to Diagnosis and Effective Management of the Disease in Pregnant Women.

Thanasa A, Thanasa E, Antoniou I, Gerokostas E, Leroutsos A, Papadoulis V Cureus. 2024; 16(8):e66524.

PMID: 39246860 PMC: 11380930. DOI: 10.7759/cureus.66524.

Acute cholecystitis in pregnant women: A therapeutic challenge in a developing country center.

Mahjoubi M, Ben Dhaou A, Maatouk M, Essid N, Rezgui B, Karoui Y Ann Hepatobiliary Pancreat Surg. 2023; 27(4):388-393.

PMID: 37915236 PMC: 10700939. DOI: 10.14701/ahbps.23-031.

Association of milk consumption with the incidence of cholelithiasis disease in the US adult population.

Jia F, Ma Y, Liu Y BMC Public Health. 2023; 23(1):1639.

PMID: 37635228 PMC: 10463673. DOI: 10.1186/s12889-023-16615-6.

The Association Between Cholecystectomy, Metabolic Syndrome, and Nonalcoholic Fatty Liver Disease: A Population-Based Study.

Latenstein C, Alferink L, Murad S, Drenth J, van Laarhoven C, de Reuver P Clin Transl Gastroenterol. 2020; 11(4):e00170.

PMID: 32352682 PMC: 7263655. DOI: 10.14309/ctg.0000000000000170.

References

Kono S, Kochi S, Ohyama S, Wakisaka A . Gallstones, serum lipids, and glucose tolerance among male officials of Self-Defense Forces in Japan. Dig Dis Sci. 1988; 33(7):839-44. DOI: 10.1007/BF01550973. View

Ainsworth B, Haskell W, Whitt M, Irwin M, Swartz A, Strath S . Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000; 32(9 Suppl):S498-504. DOI: 10.1097/00005768-200009001-00009. View

Ruhl C, Everhart J . Association of diabetes, serum insulin, and C-peptide with gallbladder disease. Hepatology. 2000; 31(2):299-303. DOI: 10.1002/hep.510310206. View

. The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Hepatology. 1988; 8(4):907-13. View

Chait A, Bierman E, Albers J . Low-density lipoprotein receptor activity in cultured human skin fibroblasts. Mechanism of insulin-induced stimulation. J Clin Invest. 1979; 64(5):1309-19. PMC: 371278. DOI: 10.1172/JCI109587. View

Jacobs Jr D, Ainsworth B, Hartman T, Leon A . A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993; 25(1):81-91. DOI: 10.1249/00005768-199301000-00012. View

Lee S, Maher K, Nicholls J . Origin and fate of biliary sludge. Gastroenterology. 1988; 94(1):170-6. DOI: 10.1016/0016-5085(88)90626-9. View

Ko C, Beresford S, Schulte S, Matsumoto A, Lee S . Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology. 2005; 41(2):359-65. DOI: 10.1002/hep.20534. View

Laakso M, Suhonen M, Julkunen R, Pyorala K . Plasma insulin, serum lipids and lipoproteins in gall stone disease in non-insulin dependent diabetic subjects: a case control study. Gut. 1990; 31(3):344-7. PMC: 1378281. DOI: 10.1136/gut.31.3.344. View

10.

Barbara L, Sama C, Morselli Labate A, Taroni F, Rusticali A, Festi D . A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology. 1987; 7(5):913-7. DOI: 10.1002/hep.1840070520. View

11.

Haffner S, Diehl A, Mitchell B, Stern M, Hazuda H . Increased prevalence of clinical gallbladder disease in subjects with non-insulin-dependent diabetes mellitus. Am J Epidemiol. 1990; 132(2):327-35. DOI: 10.1093/oxfordjournals.aje.a115662. View

12.

Graewin S, Kiely J, Lee K, Svatek C, Nakeeb A, Pitt H . Nonobese diabetic mice have diminished gallbladder motility and shortened crystal observation time. J Gastrointest Surg. 2004; 8(7):824-9. DOI: 10.1016/j.gassur.2004.06.014. View

13.

Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7):412-9. DOI: 10.1007/BF00280883. View

14.

Nakeeb A, Comuzzie A, Al-Azzawi H, Sonnenberg G, Kissebah A, Pitt H . Insulin resistance causes human gallbladder dysmotility. J Gastrointest Surg. 2006; 10(7):940-8. DOI: 10.1016/j.gassur.2006.04.005. View

15.

Jorgensen T . Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut. 1989; 30(4):528-34. PMC: 1434027. DOI: 10.1136/gut.30.4.528. View

16.

Valdivieso V, Covarrubias C, Siegel F, Cruz F . Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology. 1993; 17(1):1-4. View

17.

Haber G, Heaton K . Lipid composition of bile in diabetics and obesity-matched controls. Gut. 1979; 20(6):518-22. PMC: 1412464. DOI: 10.1136/gut.20.6.518. View

18.

de Leon M, Ferenderes R, Carulli N . Bile lipid composition and bile acid pool size in diabetes. Am J Dig Dis. 1978; 23(8):710-6. DOI: 10.1007/BF01072357. View

19.

Ness G, Zhao Z, Wiggins L . Insulin and glucagon modulate hepatic 3-hydroxy-3-methylglutaryl-coenzyme A reductase activity by affecting immunoreactive protein levels. J Biol Chem. 1994; 269(46):29168-72. View

20.

Ruhl C, Everhart J . Relationship of serum leptin concentration and other measures of adiposity with gallbladder disease. Hepatology. 2001; 34(5):877-83. DOI: 10.1053/jhep.2001.29005. View