Why gallstones form in some persons and not in others, and in particular, why the obese are predisposed to the development of gallstones is an object of continued study. In this section we discuss some of the individual and environmental factors related to increased gallstone risk and the manner in which these factors may affect the mechanisms of gallstone formation.
It has been suggested that high total caloric intake (after BMI is taken into account), meal spacing, fasting, caloric restriction and many other dietary variables can affect gallstone formation (14). We mention here some of the findings on diet composition most relevant to obesity.
Surprisingly, there is little evidence that cholesterol intake or serum total cholesterol is related to risk for formation of cholesterol gallstones. It has been suggested that since obese people have higher bile saturation indices than the non-obese, perhaps because of increased hepatic secretion of cholesterol into the bile, that dietary cholesterol may make little additional difference for these individuals (3,14).
Table 28.1 Gallstone prevalence in men
Age range (years)
Number of subjects
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