Physical activity reduces the risk of symptomatic gallstones: a prospective cohort study.
OBJECTIVE
Physical activity may prevent gallstones formation by reducing bile stasis and plasma triglycerides and elevating high-density lipoprotein cholesterol levels. This prospective study investigated the relationship of physical activity and symptomatic gallstones in both sexes, using a questionnaire validated against physiological measurements.


METHODS
A total of 25 639 volunteers, aged 40-74 years, were recruited into the European Prospective Investigation of Cancer, Norfolk and completed a questionnaire recording occupational and recreational physical activity. This questionnaire was validated earlier against measures of energy expenditure and cardio-respiratory fitness. Participants were ranked into four groups of physical activity. The cohort was monitored over 14 years for symptomatic gallstones. The primary outcome was hazard ratios (HR) of developing gallstones at 5 years, calculated using Cox regression modelling. HRs were adjusted for body mass index, alcohol, hormone replacement therapy and parity. Further analysis of a binary variable compared the highest level of physical activity against a combination of the lowest three levels.


RESULTS
After 5 years of follow-up, 135 participants (69.6% women) developed symptomatic gallstones. Comparing the highest level of physical activity against the lowest three levels, the multivariable analysis at 5 years was HR=0.30 (95% confidence interval=0.14-0.64, P=0.002). After 14 years the findings were attenuated (HR=0.70, 95% confidence interval=0.49-1.01, P=0.055).


CONCLUSIONS
The highest level of physical activity was associated with a 70% decreased risk of symptomatic gallstones after 5 years. This association may be causal as there are consistent experimental and epidemiological data for a protective effect. Physical activity should be accurately measured in studies investigating gallstones aetiology.
Norfolk and Norwich University Hospital NHS Trust, University of East Anglia, Norwich, UK. p.banim@uea.ac.uk
Paul J R
PJ
Banim
Robert N
RN
Luben
Nicholas J
NJ
Wareham
Stephen J
SJ
Sharp
Kay-Tee
KT
Khaw
Andrew R
AR
Hart
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology / Q000517:prevention & control*; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires