Gastroenterology

Gastroenterology

Volume 129, Issue 1, July 2005, Pages 105-112
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Glycemic Load, Glycemic Index, and Carbohydrate Intake in Relation to Risk of Cholecystectomy in Women

https://doi.org/10.1053/j.gastro.2005.05.016Get rights and content

Background & Aims: High-carbohydrate diets with a high glycemic response may exacerbate the metabolic consequences of the insulin-resistance syndrome. The effect on the incidence of gallstone disease is not clear. Methods: We examined the associations between high-carbohydrate diets with a high glycemic response and the risk of cholecystectomy in a cohort of women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses’ Health Study, the women reported on questionnaires mailed to them every 2 years both their carbohydrate intake and whether they had undergone cholecystectomy. Results: During 16 years of follow-up, we ascertained 5771 new cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, the relative risk for the highest compared with the lowest quintile of dietary carbohydrate was 1.35 (95% CI: 1.17–1.55, P for trend < .0001). The relative risks for the highest compared with the lowest quintile were 1.50 for glycemic load (95% CI: 1.32–1.71, P for trend < .0001) and 1.32 for glycemic index (95% CI: 1.20–1.45, P for trend < .0001). Independent positive associations were also seen for intakes of starch and sucrose. Conclusions: Our findings suggest that a higher intake of carbohydrate, dietary glycemic load, and glycemic index may enhance risk of cholecystectomy in women.

Section snippets

Study Population

The Nurses’ Health Study was initiated in 1976 when 121,700 female registered nurses, predominantly white, aged 30 to 55 years completed a mailed questionnaire on their medical history and lifestyle characteristics. Every 2 years, follow-up questionnaires were sent to update information on exposures and to identify newly diagnosed illnesses. In 1984, we collected detailed information on the carbohydrate-containing foods with an expanded 126-item, semiquantitative food-frequency questionnaire

Results

At baseline in 1984, there was an approximately 1.5-fold difference in the mean energy-adjusted carbohydrate intake between the highest and lowest quintiles in this cohort (Table 1). Women with higher carbohydrate intake tended to consume less protein and saturated, trans, monounsaturated, and polyunsaturated fats. Women who reported higher intake of carbohydrate tended to be leaner, more physically active, nonsmokers, and to consume less alcohol and coffee but more dietary fiber.

During 932,676

Discussion

In this 16-year prospective cohort study among women, we found that a higher intake of carbohydrate was positively associated with the risk of cholecystectomy. A significant positive association was also found for dietary glycemic load and glycemic index.

Studies regarding carbohydrate intake and risk of gallstone disease have been inconsistent. In a population study in Italy, a positive association was observed between a high carbohydrate intake and an increased incidence of gallstone.7 In 2

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    Supported by research grants (CA55075 and DK46200) from the National Institutes of Health.

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