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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original
Contribution / Clinical Investigation
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<-- Jordan, USA -->
Herpetic
Eye Disease and Glaucoma Related Diagnosis
[pdf version]
C. Dan Earley, Amal M Althawabi,
Paul R Cotran, Sarkis H Soukiasian
<-- Turkey, Lebanon, Australia -->
Cholelithiasis
may also be a consequence of metabolic syndrome
[pdf
version]
Mehmet Rami Helvaci, Mursel Davarci,
Orhan Veli Ozkan, Ersan Semerci, Abdulrazak
Abyad, Lesley Pocock
<-- Iran -->
SUMO1 pseudogene
3 (SUMO1P3) expression in human gastric cancer
and its clinical significance
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Hamid Reza Baradaran-Ghahfarokhi, Habib Malekpour,
Ehsan Nazemalhosseini Mojarad,
Hamid Asadzadeh Aghdaei, Majid Asadi-Samani,
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Decoy Cell
Viruria in Kidney Transplant Patients. Does
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Akram Abedi, Mojgan Mortazavi,
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Roya Akbarzadeh, Raheleh Ahmadi
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| July 2017 - Volume
15, Issue 5 |
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|
Cholelithiasis may also
be a consequence of metabolic syndrome
Mehmet Rami
Helvaci (1)
Mursel Davarci (2)
Orhan Veli Ozkan (3)
Ersan Semerci (3)
Abdulrazak Abyad (4)
Lesley Pocock (5)
(1) Specialist of Internal
Medicine, M.D.
(2) Specialist of Urology, M.D.
(3) Specialist of General Surgery, M.D.
(4) Middle-East Academy for Medicine of Aging,
Chairman, M.D., MPH, MBA, AGSF
(5) medi-WORLD International
Correspondence:
Mehmet Rami Helvaci, M.D.
07400, ALANYA,
Antalya,
Turkey
Phone: 00-90-506-4708759
Email: mramihelvaci@hotmail.com
|
Abstract
Background:
We tried to understand whether or not
there is a significant relationship between
cholelithiasis and parameters of the metabolic
syndrome.
Methods: The study was performed
in Internal Medicine Polyclinics on routine
check up patients. All cases with cholelithiasis
or already performed cholecystectomy for
cholelithiasis were put into the first
group and age and sex-matched control
cases were put into the second group.
Results: One hundred and fourty-four
cases either with cholelithiasis or already
performed cholecystectomy for cholelithiasis
were detected among 3.437 cases, totally
(4.1%). One hundred and sixteen (80.1%)
of them were female with a mean age of
53.6 years. Obesity was significantly
higher (54.8% versus 43.7%, p<0.01)
and normal weight was significantly lower
(7.6% versus 18.0%, p<0.01) in the
cholelithiasis group, and the mean body
mass indexes (BMI) were 31.0 versus 28.9
kg/m2 in them, respectively (p<0.01).
Probably parallel to the higher mean BMI,
prevalences of hypertension (26.3% versus
13.1%, p<0.001) and hypertriglyceridemia
(25.0% versus 18.0%, p<0.05) were also
higher in the cholelithiasis group, significantly.
On the other hand, hyperbetalipoproteinemia
was significantly lower in the cholelithiasis
group with unknown reasons (9.7% versus
18.0%, p<0.05).
Conclusions: Cholelithiasis is
a common pathology in society and nearly
four-fold more frequent in women, particularly
in their fifties. There are significant
relationships between cholelithiasis and
parameters of the metabolic syndrome including
female predominance, elder age, BMI, obesity,
hypertension, and hypertriglyceridemia.
On the other hand, the significantly lower
prevalence of hyperbetalipoproteinemia
in the cholelithiasis patients should
be researched with further studies.
Key words: Cholelithiasis, metabolic
syndrome, obesity, hyperbetalipoproteinemia
|
Chronic endothelial damage may be the most common
type of vasculitis and the leading cause of aging,
morbidity, and mortality in human beings. Much
higher blood pressure (BP) of the afferent vasculature
may be the major underlying cause by inducing
recurrent injuries on endothelium, and probably
whole afferent vasculature including capillaries,
are involved in the process. Thus the term of
venosclerosis is not as famous as atherosclerosis
in the literature. Secondary to the chronic endothelial
inflammation, edema, and fibrosis, vascular walls
become thickened, their lumens are narrowed, and
they lose their elastic natures that reduce blood
flow and increase systolic BP further. Some of
the well-known indicators of the inflammatory
process are sedentary life style, animal-rich
diet, overweight, smoking, alcohol, hypertriglyceridemia,
hyperbetalipoproteinemia, dyslipidemia, impaired
fasting glucose, impaired glucose tolerance, white
coat hypertension, and other chronic inflammatory
processes including rheumatologic disorders, prolonged
infections, and cancers for the development of
irreversible consequences including obesity, hypertension,
diabetes mellitus (DM), cirrhosis, peripheric
artery disease (PAD), chronic obstructive pulmonary
disease (COPD), chronic renal disease (CRD), coronary
artery disease (CAD), mesenteric ischemia, osteoporosis,
and stroke, all of which terminate with early
aging and death. Although early withdrawal of
causative factors may prevent final consequences,
after development of cirrhosis, COPD, CRD, CAD,
PAD, or stroke, endothelial changes cannot be
reversed completely due to their fibrotic natures.
They were researched under the title of metabolic
syndrome in the literature, extensively (1-4).
On the other hand, gallstone is also found among
one of the most common health problems in developed
countries (5), and it is particularly frequent
in women above the age of 40 years (6). Most of
the gallstones are found in the gallbladder, which
is also called cholelithiasis. Its pathogenesis
is uncertain and it appears to be influenced by
genetic and environmental factors (7). Excess
weight is a known and age-independent risk factor
for gallstone (8). Delayed bladder emptying, decreased
small intestinal motility, and sensitivity to
cholecystokinin were associated with obesity and
gallstone disease (9). An increased risk was confirmed
in obese diabetics with hypertriglyceridemia (10),
and plasma cholesterol levels were found related
with gallstone (11). Even more conflicting results
were reported about an association between gallstone
and smoking (12-14). We tried to understand whether
or not there is a significant relationship between
cholelithiasis and parameters of the metabolic
syndrome.
The study was performed in Internal Medicine
Polyclinics of the Dumlupinar and Mustafa Kemal
Universities on routine check up of patients
between August 2005 and November 2007. We took
consecutive patients below the age of 70 years
to avoid debility induced weight loss in elders.
Their medical histories, including smoking habit,
hypertension, DM, dyslipidemia, and already
used medications and performed operations were
learnt, and a routine check up procedure including
fasting plasma glucose (FPG), triglyceride,
high density lipoprotein cholesterol (HDL-C),
low density lipoprotein cholesterol (LDL-C),
and an abdominal ultrasonography was performed.
Patients with devastating illnesses including
type 1 DM, malignancies, acute or chronic renal
failure, chronic liver diseases, hyper- or hypothyroidism,
and heart failure were excluded to avoid their
possible effects on weight. Current daily smokers
for the last six months and cases with a history
of five pack-years were accepted as smokers.
Cigar or pipe smokers were excluded. Body mass
index (BMI) of each case was calculated by the
measurements of the same physician instead of
verbal expressions since there is evidence that
heavier individuals systematically underreport
their weight (15). Weight in kilograms is divided
by height in meters squared, and underweight
is defined as a BMI of lower than 18.5, normal
weight as 18.5-24.9, overweight as 25.0-29.9,
and obesity as a BMI of 30.0 kg/m2 or greater
(16). Cases with an overnight FPG level of 126
mg/dL or greater on two occasions or already
receiving antidiabetic medications were defined
as diabetics (16). An oral glucose tolerance
test with 75-gram glucose was performed in cases
with a FPG level between 110 and 125 mg/dL,
and diagnosis of cases with a 2-hour plasma
glucose level 200 mg/dL or greater is DM (16).
Patients with dyslipidemia were detected, and
we used the National Cholesterol Education Program
Expert Panel's recommendations for defining
dyslipidemic subgroups (16). Dyslipidemia is
diagnosed when LDL-C is 160 or higher and/or
TG is 200 or higher and/or HDL-C is lower than
40 mg/dL. Office BP was checked after a 5-minute
rest in seated position, with a mercury sphygmomanometer
on three visits, and no smoking was permitted
during the previous 2 hours. A 10-day twice
daily measurement of blood pressure at home
(HBP) was obtained in all cases, even in normotensives
in the office due to the risk of masked hypertension
after a 10-minute education session about proper
BP measurement techniques (17). The education
included recommendation of upper arm while discouraging
wrist and finger devices, using a standard adult
cuff with bladder sizes of 12 x 26 cm for arm
circumferences up to 33 cm in length and a large
adult cuff with bladder sizes of 12 x 40 cm
for arm circumferences up to 50 cm in length,
and taking a rest at least for a period of 5
minutes in the seated position before measurement.
An additional 24-hour ambulatory BP monitoring
was not required due to the equal efficacy of
the method with HBP measurement to diagnose
hypertension (18). Eventually, hypertension
is defined as a BP of 135/85 mmHg or greater
on HBP measurements (17). Cholelithiasis was
diagnosed ultrasonographically. Eventually,
all cases either with presenting cholelithiasis
or already performed cholecystectomy for cholelithiasis
were put into the first group and age and sex-matched
control cases were put into the second groups.
Prevalences of smoking, normal weight, overweight,
obesity, hypertension, DM, hypertriglyceridemia,
hyperbetalipoproteinemia, and dyslipidemia and
mean BMI values were detected in both groups
and compared in between. Mann-Whitney U test,
Independent-Samples t test, and comparison of
proportions were used as the methods of statistical
analyses.
Although
the
exclusion
criteria,
119
cases
with
cholecystectomy
for
cholelithiasis
and
25
with
already
presenting
asymptomatic
cholelithiasis
were
detected
among
3.437
cases,
total
(4.1%).
One
hundred
and
sixteen
(80.1%)
of
them
were
female
with
a
mean
age
of
53.6
years,
so
cholelithiasis
is
mainly
a
disorder
of
females
in
their
fifties.
Prevalences
of
smoking
were
similar
in
the
cholelithiasis
and
control
groups
(18.0%
versus
19.4%,
p>0.05,
respectively).
There
was
not
any
patient
with
underweight.
Interestingly,
92.3%
(133
cases)
of
the
cholelithiasis
group
had
excess
weight
and
only
7.6%
(11
cases)
of
them
had
normal
weight.
Obesity
was
significantly
higher
(54.8%
versus
43.7%,
p<0.01)
and
normal
weight
was
significantly
lower
(7.6%
versus
18.0%,
p<0.01)
in
the
cholelithiasis
group.
Mean
BMI
values
were
31.0
and
28.9
kg/m2,
(p<0.01)
in
them.
Probably
parallel
to
the
higher
mean
BMI,
prevalences
of
hypertension
(26.3%
versus
13.1%,
p<0.001)
and
hypertriglyceridemia
(25.0%
versus
18.0%,
p<0.05)
were
also
higher
in
the
cholelithiasis
group,
significantly.
Differences
were
nonsignificant
according
to
the
prevalences
of
DM
and
dyslipidemia.
On
the
other
hand,
hyperbetalipoproteinemia
was
significantly
lower
in
the
cholelithiasis
group
with
unknown
reasons
(9.7%
versus
18.0%,
p<0.05)
(Table
1).
Table
1:
Comparison
of
cases
with
and
without
cholelithiasis
*Nonsignificant
(p>0.05)
†Body
mass
index
‡Diabetes
mellitus
Excess
weight
leads
to
both
structural
and
functional
abnormalities
of
many
organ
systems
of
the
body.
Recent
studies
revealed
that
adipose
tissue
produces
biologically
active
leptin,
tumor
necrosis
factor-alpha,
plasminogen
activator
inhibitor-1,
and
adiponectin
which
are
closely
related
with
the
development
of
complications
(19).
For
instance,
the
cardiovascular
field
has
recently
shown
a
great
interest
in
the
role
of
inflammation
in
development
of
atherosclerosis
and
numerous
studies
indicated
that
inflammation
plays
a
significant
role
in
the
pathogenesis
of
atherosclerosis
and
thrombosis
(20,
21).
Adipose
tissue
is
involved
in
the
regulation
of
cytokines
(22).
On
the
other
hand,
individuals
with
excess
weight
will
have
an
increased
circulating
blood
volume
as
well
as
an
increased
cardiac
output,
thought
to
be
the
result
of
increased
oxygen
demand
of
the
excessive
fat
tissue.
The
prolonged
increase
in
circulating
blood
volume
can
lead
to
myocardial
hypertrophy
and
decreased
compliance,
in
addition
to
the
common
comorbidity
of
hypertension.
In
addition
to
the
hypertension,
the
prevalences
of
high
FPG,
high
serum
total
cholesterol,
and
low
HDL-C,
and
their
clustering
were
all
raised
with
the
higher
BMI
(23).
Combination
of
these
cardiovascular
risk
factors
will
eventually
lead
to
an
increase
in
left
ventricular
stroke
with
higher
risks
of
arrhythmias,
cardiac
failure,
and
sudden
cardiac
death.
Similarly,
the
incidences
of
CHD
and
stroke
have
increased
with
a
higher
BMI
in
the
other
studies
(23,
24),
and
risk
of
death
from
all
causes
including
cancers
increases
throughout
the
range
of
moderate
and
severe
excess
weight
for
both
genders
in
all
age
groups
(25).
As
another
consequence
of
excess
weight
on
health,
the
cholelithiasis
cases
had
a
significantly
higher
mean
BMI
in
the
present
study
(31.0
versus
28.9
kg/m2,
p<0.01)
similar
to
the
previous
reports
(8,
9).
Probably
as
a
consequence
of
the
significantly
higher
BMI,
the
prevalences
of
hypertension
(26.3%
versus
13.1%,
p<0.001)
and
hypertriglyceridemia
(25.0%
versus
18.0%,
p<0.05)
were
also
higher
in
the
cholelithiasis
patients.
The
relationship
between
excess
weight
and
elevated
BP
and
hypertriglyceridemia
is
already
described
in
the
metabolic
syndrome
(26),
and
clinical
manifestations
of
the
syndrome
include
obesity,
dyslipidemia,
hypertension,
insulin
resistance,
and
proinflammatory
as
well
as
prothrombotic
states
(27).
The
above
confirmed
increased
risk
of
cholelithiasis
in
obese
diabetics
with
hypertriglyceridemia
may
also
be
an
indicator
of
its
association
with
the
metabolic
syndrome
(10,
26).
Although
the
presence
of
some
conflicting
results
in
the
literature
(12-14),
we
did
not
find
any
significant
association
between
cholelithiasis
and
smoking
in
the
present
study
(p>0.05).
On
the
other
hand,
the
lower
prevalence
of
hyperbetalipoproteinemia
in
the
cholelithiasis
patients
in
the
present
study
(9.7%
versus
18.0%,
p<0.05),
although
the
significantly
higher
mean
BMI
values
of
them,
should
be
researched
with
further
studies.
As
a
conclusion,
cholelithiasis
is
a
common
pathology
in
society
and
nearly
four-fold
more
frequent
in
women,
particularly
in
their
fifties.
There
are
significant
relationships
between
cholelithiasis
and
parameters
of
the
metabolic
syndrome
including
female
predominance,
elder
age,
BMI,
obesity,
hypertension,
and
hypertriglyceridemia.
On
the
other
hand,
the
significantly
lower
prevalence
of
hyperbetalipoproteinemia
in
the
cholelithiasis
patients
should
be
researched
with
further
studies.
1.
Eckel
RH,
Grundy
SM,
Zimmet
PZ.
The
metabolic
syndrome.
Lancet
2005;
365:
1415-1428.
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Helvaci
MR,
Kaya
H,
Sevinc
A,
Camci
C.
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weight
and
white
coat
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MR,
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LY,
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Y.
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an
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MR,
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Y,
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M.
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of
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of
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S.
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in
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EM,
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Ierland-Van
Leeuwen
ML,
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A.
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of
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in
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M,
Pagliarulo
M,
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A,
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F,
Ferrando
J,
Caldentey
M,
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MJ,
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A,
et
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T.
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in
a
Danish
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physical
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smoking,
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L,
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JM,
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M.
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Funahashi
T,
Nakamura
T,
Shimomura
I,
Maeda
K,
Kuriyama
H,
Takahashi
M,
et
al.
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of
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on
the
pathogenesis
of
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