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a Laboratorio di
Epidemiologia, IRCCS "S de Bellis", Ospedale Gastroenterologico,
Castellana, Bari, Italy, b Laboratorio di Biochimica, IRCCS "S de
Bellis", Ospedale Gastroenterologico, Castellana, Bari, Italy, c Department
of Social and Preventive Medicine, School of Medicine and Biomedical
Sciences, State University of New York at Buffalo, Buffalo, New York,
USA
Correspondence to: Professor M Trevisan, Department of Social and Preventive Medicine, School of Medicine and Biomedical Sciences, 270 Farber Hall, 3435 Main Street, Buffalo, New York 14214-3000, USA. Email: trevisan{at}buffalo.edu
Accepted for publication 8 February 2000
BACKGROUND
Hyperinsulinaemia
has been associated with many common diseases in developed countries,
such as ischaemic heart disease and colon cancer. Gall stones are also
very prevalent in these countries but little is known about the
association between insulin and gall stones.
AIMSTo study the
relationships between insulin and the incidence of gall stones in a
sample of the general population.
SUBJECTS AND
METHODSBetween May 1985 and June 1986, systematic
sampling from the electoral register of Castellana, a small town in
southern Italy, yielded 2472 subjects who had their gall bladder
checked for gall stones by ultrasonography. Between May 1992 and June
1993, 1962 of the 2235 subjects without gall stones at the first
examination agreed to a further ultrasound examination. A total of 101 subjects with newly diagnosed gall stones and 303 randomly chosen
controls entered the study. Serum insulin was determined by
radioimmunoassay, and concentrations of cholesterol, cholesterol high
density lipoprotein (HDL), glucose, and triglycerides by standard
enzymatic colorimetric methods. Unconditional multiple logistic
regression was used to study the association between insulin and gall
stones, controlling for the most common confounding factors.
RESULTSIn individuals
with no clinical diagnosis of diabetes and serum glucose <7 mmol/l,
insulin was associated with gall stones. This association persisted
even after controlling for sex, age, body mass index, and serum
glucose. The risk of gall stones in the highest quintile of serum
insulin was 2.66 (95% confidence interval 1.04-6.72; 
2
test for trend, p=0.03). The association of insulin with gall stones
persisted when total and HDL cholesterol were entered in the logistic
regression models, and only slightly decreased when serum triglycerides
were included in the model.
CONCLUSIONSThe
results of the study indicate that hyperinsulinaemia may play an
important role in the aetiology of gall stones even in individuals
without diabetes and with normal serum glucose levels.
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  S.-C. Chang, A. Rashid, Y.-T. Gao, G. Andreotti, M.-C. Shen, B.-S. Wang, T.-Q. Han, B.-H. Zhang, L. C. Sakoda, M. F. Leitzmann, et al. Polymorphism of genes related to insulin sensitivity and the risk of biliary tract cancer and biliary stone: a population-based case-control study in Shanghai, China Carcinogenesis, May 1, 2008; 29(5): 944 - 948. [Abstract] [Full Text] [PDF]
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 K W HEATON, P M EMMETT, G MISCIAGNA, and M TREVISAN Insulin and gall stones Gut, May 1, 2001; 48(5): 737a - 738. [Full Text] [PDF]
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