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Dietary intake and gallbladder disease: a review

Published online by Cambridge University Press:  02 January 2007

Marilyn Tseng ,
James E Everhart  and
Robert S Sandler
Marilyn Tseng*
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA
James E Everhart
Affiliation:
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
Robert S Sandler
Affiliation:
Division of Digestive Diseases and Nutrition, Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
*
*Corresponding author: Email m_tseng@fccc.edu
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Abstract

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Objective

Dietary intake has long been looked upon as a potentially modifiable risk factor for gallbladder disease (GBD), here defined as either having gallstones or having had surgery for gallstones. This paper reviews the epidemiological evidence for an association between dietary intake and GBD, focusing on six dietary factors that have received the most attention in studies in this area: energy intake, fatty acids, cholesterol, carbohydrates and fibre, calcium and alcohol. The objectives of this review are to evaluate the potential usefulness of altering the diet to prevent GBD and to consider future research in this area.

Design

We reviewed all English-language epidemiological studies on diet and cholelithiasis that were cross-sectional, cohort or case–control in design and that were indexed in the Medline database from 1966 to October 1997.

Results

A positive association was suggested with simple sugars and inverse associations with dietary fibre and alcohol. No convincing evidence was found for a role for energy intake or intake of fat or cholesterol. Variable means of ascertaining cases and inaccurate measurement of dietary intake may contribute to variation in results across studies.

Conclusions

Some specific components of the diet that may affect GBD include simple sugars, fibre and alcohol, but whether risk for GBD can be reduced by altering intake of a specific dietary factor has not been established. Although no specific dietary recommendations can be made to reduce risk of GBD per se, a ‘healthy’ diet aimed at reducing risk of other diseases might be expected to reduce risk for GBD as well.

Keywords

CholelithiasisDietEnergy intakeDietary fatsCholesterolFibreSucroseAlcohol
Type
Research Article
Information
Public Health Nutrition , Volume 2 , Issue 2 , February 1999 , pp. 161 - 172
Copyright
Copyright © CABI Publishing 1999

References

1Everhart, JE. Gallstones. In: Everhart, J, ed. Digestive Diseases in the United States: Epidemiology and Impact. NIH Publication No. 94–1447. Washington, DC: US Government Printing Office, 1994: 647–90.Google Scholar
2Diehl, AK. Epidemiology and natural history of gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 1–19.CrossRefGoogle ScholarPubMed
3Sama, C, Labate, AMM, Taroni, F, Barbara, L. Epidemiology and natural history of gallstone disease. Semin. Liver Dis. 1990; 10: 149–58.CrossRefGoogle ScholarPubMed
4Everhart, JE. Contributions of obesity and weight loss to gallstone disease. Ann. Intern. Med. 1993; 119: 1029–35.CrossRefGoogle ScholarPubMed
5Messing, B, Bories, C, Kunstlinger, F, Bernier, JJ. Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology 1983; 84: 1012–19.CrossRefGoogle ScholarPubMed
6Roslyn, JJ, Pitt, HA, Mann, LL, Ament, ME, DenBesten, L. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 1983; 84: 148–54.CrossRefGoogle ScholarPubMed
7Holzbach, RT. Gallbladder stasis: consequence of long-term parenteral hyperalimentation and risk factor for cholelithiasis. Gastroenterology 1983; 84: 1055–8.CrossRefGoogle ScholarPubMed
8Hayes, KC, Livingston, A, Trautwein, EA. Dietary impact on biliary lipids and gallstones. Annu. Rev. Nutr. 1992; 12: 299–326.CrossRefGoogle ScholarPubMed
9Cooper, AD. Epidemiology, pathogenesis, natural history, and medical therapy of gallstones. In: Sleisenger, MH, ed. Gastrointestinal Diseases: Pathophysiology, Diagnosis, Management. Philadelphia: WB Saunders Company, 1993.Google Scholar
10Cooper, AD. Metabolic basis of cholesterol gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 21–46.CrossRefGoogle ScholarPubMed
11Carey, MC. Pathogenesis of gallstones. Am. J. Surgery 1993; 165: 410–19.CrossRefGoogle ScholarPubMed
12Everson, GT. Gallbladder function in gallstone disease. Gastroenterol. Clin. North Am. 1991; 20: 85–110.CrossRefGoogle ScholarPubMed
13Donovan, JM, Carey, MC. Physical-chemical basis of gallstone formation. Gastroenterol. Clin. North Am. 1991; 20: 47–66.CrossRefGoogle ScholarPubMed
14Holzbach, RT, Busch, N. Nucleation and growth of cholesterol crystals: kinetic determinants in supersaturated native bile. Gastroenterol. Clin. North Am. 1991; 20: 67–84.CrossRefGoogle ScholarPubMed
15Heaton, KW, Braddon, REM, Mountford, RA, Emmitt, PM. Symptomatic and silent gall stones in the community. Gut 1991; 32: 316–20.CrossRefGoogle ScholarPubMed
16Zeman, RK. Noninvasive imaging of the biliary tract. In: Haubrich, WS, Schaffner, F, Berk, JE, eds. Bockus Gastroenterology, Vol. 3. Philadelphia: WB Saunders Company, 1995: 2573–96.Google Scholar
17Diehl, AK, Schwesinger, WH, Holleman, DR JrChapman, JB, Kurtin, WE. Clinical correlates of gallstone composition: distinguishing pigment from cholesterol stones. Am. J. Gastroenterol. 1995; 90: 967–72.Google ScholarPubMed
18Mok, HY, Druffel, ER, Rampone, WM. Chronology of cholelithiasis. Dating gallstones from atmospheric radiocarbon produced by nuclear bomb explosions. N. Engl. J. Med. 1986; 314: 1075–7.CrossRefGoogle ScholarPubMed
19Thijs, C, Knipschild, P, Leffers, P. Does alcohol protect against the formation of gallstones? A demonstration of protopathic bias. J. Clin. Epidemiol. 1991; 44: 941–6.Google ScholarPubMed
20Van der Linden, W, Bergman, F. Formation and dissolution of gallstones in experimental animals. Int. Rev. Exp. Pathol. 1977; 17: 173–233.Google ScholarPubMed
21Maurer, KR, Everhart, JE, Knowler, WC, Shawker, TH, Roth, HP. Risk factors for gallstone disease in the Hispanic populations of the United States. Am. J. Epidemiol. 1990; 131: 836–44.CrossRefGoogle ScholarPubMed
22Hanis, CL, Hewett-Emmett, D, Kubrusly, LF, et al. An ultrasound survey of gallbladder disease among Mexican Americans in Starr County, Texas: frequencies and risk factors. Ethnicity Dis. 1993; 3: 32–43.Google ScholarPubMed
23Williams, CN, Johnston, JL, Weldon, KLM. Prevalence of gallstones and gallbladder disease in Canadian Micmac Indian women. Can. Med. Assoc. J. 1977; 117: 758–60.Google ScholarPubMed
24Williams, CN, Johnston, JL. Prevalence of gallstones and risk factors in Caucasian women in a rural Canadian community. Can. Med. Assoc. J. 1980; 122: 664–8.Google Scholar
25Jørgensen, T, Kay, L, Schultz-Larsen, K. The epidemiology of gallstones in a 70-year-old Danish population. Scand. J. Gastroenterol. 1990; 25: 335–40.CrossRefGoogle Scholar
26Rhomberg, HP, Judmair, G, Lochs, A. How common are gall stones? BMJ 1984; 289: 1002.CrossRefGoogle Scholar
27Pixley, F, Wilson, D, McPherson, K, Mann, J. Effect of vegetarianism on development of gall stones in women. BMJ 1985; 291: 11–12.CrossRefGoogle ScholarPubMed
28Kono, 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: 839–44.CrossRefGoogle ScholarPubMed
29Kono, S, Shinchi, K, Ikeda, N, Yanai, F, Imanishi, K. Prevalence of gallstone disease in relation to smoking, alcohol use, obesity, and glucose tolerance: a study of self-defense officials in Japan. Am. J. Epidemiol. 1992; 136: 787–94.CrossRefGoogle ScholarPubMed
30Kono, S, Shinchi, K, Todoroki, I et al. Gallstone disease among Japanese men in relation to obesity, glucose intolerance, exercise, alcohol use, and smoking. Scand. J. Gastroenterol. 1995; 30: 372–6.CrossRefGoogle ScholarPubMed
31Jørgensen, T. Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut 1989; 30: 528–34.CrossRefGoogle Scholar
32Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. II. Factors associated with the disease. Hepatology 1988; 8: 907–13.CrossRefGoogle Scholar
33Khuroo, MS, Mahajan, R, Zargar, SA, Javid, G, Sapru, S. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989; 30: 201–5.CrossRefGoogle ScholarPubMed
34Barbara, L, Sama, C, Labate, AMM, et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913–17.CrossRefGoogle Scholar
35Barbara, L, Festi, D, Frabboni, R et al. Incidence and risk factors for gallstone disease: the ‘Sirmione study’. Hepatology 1988; 8: 1256.Google Scholar
36Khare, M, Everhart, JE, Maurer, KR, Hill, MC. Association of ethnicity and body mass index (BMI) with gallstone disease in the United States. Am. J. Epidemiol. 1996; 141 (Suppl.): S69.Google Scholar
37Friedman, GD, Kannel, WB, Dawber, TR. The epidemiology of gallbladder disease: observations in the Framingham study. J. Chron. Dis. 1966; 19: 273–92.CrossRefGoogle ScholarPubMed
38Layde, PM, Vessey, MP, Yeates, D. Risk factors for gall-bladder disease: a cohort study of young women attending family planning clinics. J. Epidemiol. Community Health 1982; 36: 274–8.CrossRefGoogle ScholarPubMed
39Maclure, KM, Hayes, KC, Colditz, GA, Stampfer, MJ, Speizer, FE, Willett, WC. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N. Engl. J. Med. 1989; 321: 563–9.CrossRefGoogle ScholarPubMed
40Stampfer, MJ, Maclure, KM, Colditz, GA, Mansun, JAE, Willett, WC. Risk of symptomatic gallstones in women with severe obesity. Am. J. Clin. Nutr. 1992; 55: 652–8.CrossRefGoogle ScholarPubMed
41Grodstein, F, Colditz, GA, Hunter, DJ, Mansun, JE, Willett, WC, Stampfer, MJ. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstet. Gynecol. 1994; 84: 207–14.Google ScholarPubMed
42Kato, I, Nomura, A, Stemmermann, GN, Chyou, PH. Prospective study of clinical gallbladder disease and its association with obesity, physical activity, and other factors. Dig. Dis. Sci. 1992; 37: 784–90.CrossRefGoogle ScholarPubMed
43La Vecchia, C, Negri, E, D'Avanzo, B, Franceschi, S, Boyle, P. Risk factors for gallstone disease requiring surgery. Int. J. Epidemiol. 1991; 20: 209–15.CrossRefGoogle ScholarPubMed
44Scragg, KR, McMichael, AJ, Baghurst, PA. Diet, alcohol, and relative weight in gall stone disease: a case-control study. BMJ 1984; 288: 1113–19.CrossRefGoogle ScholarPubMed
45Basso, L, McCollum, PT, Darling, MR, Tocchi, A, Tanner, WA. A descriptive study of pregnant women with gallstones. Relation to dietary and social habits, education, physical activity, height, and weight. Eur. J. Epidemiol. 1992; 8: 629–33.CrossRefGoogle ScholarPubMed
46Maringhini, A, Marceno, MP, Lanzarone, F et al. Sludge and stones in gallbladder after pregnancy. Prevalence and risk factors. J. Hepatol. 1987; 5: 218–23.CrossRefGoogle ScholarPubMed
47Heaton, KW. The role of diet in the aetiology of cholelithiasis. In: Capocaccia, L, Ricci, G, Angelico, F, Angelico, M, Attili, AF, eds. Epidemiology and Prevention of Gallstone Disease. Lancaster: MTP Press, 1984.Google Scholar
48Burkitt, DP, Tunstall, M. Gallstones: geographical and chronological features. J. Trop. Med. Hyg. 1975; 78: 140–4.Google ScholarPubMed
49Brett, M, Barker, DJP. The world distribution of gallstones. Int. J. Epidemiol. 1976; 5: 335–41.CrossRefGoogle ScholarPubMed
50Malhotra, SL. Epidemiological study of cholelithiasis among railroad workers in India with special to causation. Gut 1968; 9: 290–5.CrossRefGoogle ScholarPubMed
51Sarles, H, Gerolami, A, Bord, A. Diet and cholesterol gallstones: a further study. Digestion 1978; 17: 128–34.CrossRefGoogle ScholarPubMed
52Nakayama, F, Miyake, H. Changing state of gallstone disease in Japan. Am. J. Surg. 1970; 120: 794–9.CrossRefGoogle ScholarPubMed
53Sarles, H, Chabert, C, Pommeau, Y, Save, E, Mouret, H, Gerolami, A. Diet and cholesterol gallstones: a study of 101 patients with cholelithiasis compared to 101 matched controls. Am. J. Dig. Dis. 1969; 14: 531–7.CrossRefGoogle ScholarPubMed
54Tandon, RK, Saraya, A, Paul, S, Kapur, BML. Dietary habits of gallstone patients in northern India. J. Clin. Gastroenterol. 1996; 22: 23–7.CrossRefGoogle ScholarPubMed
55Ortega, RM, Fernández-Azuela, M, Encinas-Sotillos, A, Andrés, P, López-Sobaler, AM. Differences in diet and food habits between patients with gallstones and controls. J. Am. Coll. Nutr. 1997; 16: 88–95.CrossRefGoogle ScholarPubMed
56Wheeler, M, Hills, LL, Laby, B. Cholelithiasis: a clinical and dietary survey. Gut 1970; 11: 430–7.CrossRefGoogle ScholarPubMed
57Smith, DA, Gee, MI. A dietary survey to determine the relationship between diet and cholelithiasis. Am. J. Clin. Nutr. 1979; 32: 1519–26.CrossRefGoogle ScholarPubMed
58Pixley, F, Mann, J. Dietary factors in the aetiology of gall stones: a case-control study. Gut 1988; 29: 1511–15.CrossRefGoogle ScholarPubMed
59Worthington, HV, Hunt, LP, McCloy, RF, Maclennan, I, Braganza, JM. A pilot study of antioxidant intake in patients with cholesterol gallstones. Nutrition 1997; 13: 118–27.CrossRefGoogle ScholarPubMed
60Sarin, SK, Negi, VS, Dewan, R, Sasan, S, Saraya, A. High familial prevalence of gallstones in the first-degree relatives of gallstone patients. Hepatology 1995; 22: 138–41.Google ScholarPubMed
61Sichieri, R, Everhart, JE, Roth, H. A prospective study of hospitalization with gallstone disease among women: role of dietary factors, fasting period, and dieting. Am. J. Public Health 1991; 81: 880–4.CrossRefGoogle ScholarPubMed
62Low-Beer, TS. Nutrition and cholesterol gallstones. Proc. Nutr. Soc. 1985; 44: 127–34.CrossRefGoogle ScholarPubMed
63Reid, SM, Fullmer, SD, Pettigrew, KD et al. Nutrient intake of Pima Indian women: relationships to diabetes mellitus and gallbladder disease. Am. J. Clin. Nutr. 1971; 24: 1281–9.CrossRefGoogle ScholarPubMed
64Wysowski, DK, Goldberg, EL, Comstock, GW, Diamond, EL. A study of a possible association between breast cancer and gallbladder disease. Am. J. Epidemiol. 1986; 123: 532–43.CrossRefGoogle ScholarPubMed
65Jørgensen, T, Jørgensen, LM. Gallstones and diet in a Danish population. Scand. J. Gastroenterol. 1989; 24: 821–6.CrossRefGoogle Scholar
66Diehl, AK, Haffner, SM, Knapp, JA, Hazuda, HP, Stern, MP. Dietary intake and the prevalence of gallbladder disease in Mexican Americans. Gastroenterology 1989; 97: 1527–33.CrossRefGoogle ScholarPubMed
67Moerman, CJ, Smeets, FWM, Kromhout, D. Dietary risk factors for clinically diagnosed gallstones in middle-aged men. Ann. Epidemiol. 1994; 4: 248–54.CrossRefGoogle ScholarPubMed
68Sturdevant, R, Pearce, M, Dayton, S. Increased prevalence of cholelithiasis in men ingesting a serum-cholesterol-lowering diet. N. Engl. J. Med. 1973; 288: 24–7.CrossRefGoogle ScholarPubMed
69Miettinen, M, Turpeinen, O, Karvonen, M, Paavilainen, E, Elosuo, R. Prevalence of cholelithiasis in men and women ingesting a serum-cholesterol-lowering diet. Ann. Clin. Res. 1976; 8: 111–16.Google ScholarPubMed
70Kato, I, Kato, K, Akai, S, Tominaga, S. A case-control study of gallstones: a major risk factor for biliary tract cancer. Jpn J. Cancer Res. 1990; 81: 578–83.CrossRefGoogle Scholar
71Maclure, KM, Hayes, KC, Colditz, GA, Stampfer, MJ, Willett, WC. Dietary predictors of symptom-associated gallstones in middle-aged women. Am. J. Clin. Nutr. 1990; 52: 916–22.CrossRefGoogle ScholarPubMed
72Misciagna, G, Leoci, C, Guerra, V et al. Epidemiology of cholelithiasis in southern Italy. Eur. J. Gastroenterol. Hepatol. 1996; 8: 585–93.CrossRefGoogle ScholarPubMed
73Pastides, H, Tzonou, A, Trichopoulos, D et al. A case-control study of the relationship between smoking, diet, and gallbladder disease. Arch. Intern. Med. 1990; 150: 1409–12.CrossRefGoogle ScholarPubMed
74Berr, F, Holl, J, Jungst, D et al. Dietary n-3 polyunsaturated fatty acids decrease biliary cholesterol saturation in gallstone disease. Hepatology 1992; 16: 960–7.CrossRefGoogle ScholarPubMed
75Nestel, PJ. Effects of n-3 fatty acids on lipid metabolism. Annu. Rev. Nutr. 1990; 10: 149–67.CrossRefGoogle ScholarPubMed
76Attili, AF. Dietary habits and cholelithiasis. In: Capocaccia, L, Ricci, G, Angelico, F, Angelico, M, Attili, AF, eds. Epidemiology and Prevention of Gallstone Disease. Lancaster, UK: MTP Press, 1984: 175–81.CrossRefGoogle Scholar
77DenBesten, L, Connor, WE, Bell, S. The effect of dietary cholesterol on the composition of human bile. Surgery 1973; 73: 266–73.Google ScholarPubMed
78Lee, DWT, Gilmore, CJ, Bonorris, G et al. Effect of dietary cholesterol on biliary lipids in patients with gallstones and normal subjects. Am. J. Clin. Nutr. 1985; 42: 414–20.CrossRefGoogle ScholarPubMed
79Kern, F Jr. Effects of dietary cholesterol on cholesterol and bile acid homeostasis in patients with cholesterol gallstones. J. Clin. Invest. 1994; 93: 1186–94.CrossRefGoogle ScholarPubMed
80Dam, H, Prange, I, Jensen, MK, Kallehauge, HE, Fenger, HJ. Studies on human bile. IV. Influence of ingestion of cholesterol in the form of eggs on the composition of bile in healthy subjects. Z. Ernahrungswiss. 1971; 10: 178–87.CrossRefGoogle ScholarPubMed
81Andersen, E, Hellstrom, K. The effect of cholesterol feeding on bile acid kinetics and biliary lipids in normolipidemic and hypertriglyceridemic subjects. J. Lipid Res. 1979; 20: 1020–7.CrossRefGoogle ScholarPubMed
82Everson, GT, McKinley, C, Kern, F Jr. Mechanisms of gallstone formation in women: effects of exogenous estrogen (Premarin®) and dietary cholesterol on hepatic lipid metabolism. J. Clin. Invest. 1991; 87: 237–46.CrossRefGoogle ScholarPubMed
83Ahmed, AF, Osman, AK, Bustami, AB, Aldirwish, S, Bashir, S. A pilot study of diet and gallstone formation in young Saudi women. J. R. Soc. Health 1993; 113: 57–9.CrossRefGoogle ScholarPubMed
84Marcus, SN, Wheaton, KW. Intestinal transit rate, deoxycholic acid and the cholesterol saturation of bile — three interrelated factors. Gut 1986; 27: 550–8.CrossRefGoogle Scholar
85Marcus, SN, Wheaton, KW. Effects of a new, concentrated wheat fiber preparation on intestinal transit, deoxycholic acid metabolism and the composition of bile. Gut 1986; 27: 893–900.CrossRefGoogle ScholarPubMed
86Alessandrini, A, Busco, MA, Gatti, E, Rossi, PA. Dietary fibres and cholesterol gallstones: a case control study. Ital. J. Gastroenterol. 1982; 14: 156–8.Google Scholar
87Hood, KA, Gleeson, D, Ruppin, DC, Dowling, RH. Gall stone recurrence and its prevention: the British/Belgian Gall Stone Study Group's post-dissolution trial. Gut 1993; 9: 1277–88.CrossRefGoogle Scholar
88Linos, AD, Daras, V, Linos, DA, Kekis, V, Tsoukas, MM, Golematis, V. Dietary and other risk factors in the aetiology of cholelithiasis: a case control study. HPB Surg. 1989; 1: 221–7.CrossRefGoogle ScholarPubMed
89Thornton, J, Symes, C, Heaton, K. Moderate alcohol intake reduces bile cholesterol saturation and raises HDL cholesterol. Lancet 1983; 2: 819–22.CrossRefGoogle ScholarPubMed
90La Vecchia, C, Decarli, A, Ferraroni, M, Negri, E. Alcohol drinking and prevalence of self-reported gallstone disease in the 1983 Italian National Health Survey. Epidemiology 1994; 5: 533–6.Google ScholarPubMed
91Fornari, F, Civardi, G, Buscarini, E et al. Cirrhosis of the liver. A risk factor for development of cholelithiasis in males. Dig. Dis. Sci. 1990; 35: 1403–8.CrossRefGoogle ScholarPubMed
92Acalovschi, M, Badea, R, Dumitrascu, D, Varga, C. Prevalence of gallstones in liver cirrhosis: a sonographic survey. Am. J. Gastroenterol. 1988; 83: 954–6.Google ScholarPubMed
93Kratzer, W, Kächele, V, Mason, RA et al. Gallstone prevalence in relation to smoking, alcohol, coffee consumption, and nutrition. Scand. J. Gastroenterol. 1997; 32: 953–8.CrossRefGoogle ScholarPubMed
94Abdel-Rahman, HA, Hafez, AS, Maymoun, NM et al. Risk factors of gallstone disease in a sample of patients in Benha City. J. Egypt. Public Health Assoc. 1993; 68: 205–27.Google Scholar
95Leitzmann, MF, Giovannucci, E, Rimm, EB, Stampfer, MJ, Willett, WC. Physical activity and the risk of gallstone disease in men. Ann. Intern. Med. 1998; 128: 415–25.CrossRefGoogle ScholarPubMed
96US Department of Agriculture/US Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC: US Government Printing Office, 1990.Google Scholar
97US Department of Agriculture/US Department of Health and Human Services. The Food Guide Pyramid. Washington, DC: US Government Printing Office, 1992.Google Scholar
98Sama, C, Morselli Labate, AMCornia, GL et al. Dietary habit and cholelithiasis: results of an epidemiological study. Hepatology 1985; 5: 984.Google Scholar
99Diehl, AK, Haffner, SM, Hazuda, HP, Stern, MP. Coronary risk factors and clinical gallbladder disease: an approach to the prevention of gallstones?. Am. J. Public Health 1987; 77: 841–5.CrossRefGoogle Scholar
100Klatsky, AL, Friedman, GD, Siegelaub, AB. Alcohol use and cardiovascular disease: the Kaiser–Permanente experience. Circulation 1981; 64 (Suppl. III): 32–41.Google ScholarPubMed