title: The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study.
abstract: OBJECTIVE
  This study used autopsy to evaluate the prevalence of cholelithiasis and its associated risk factors in a population of healthy, young subjects who suffered a violent or natural death.
  
  
  METHODS
  This study is a prospective evaluation of autopsies of 446 individuals from 2011 to 2013 in Brazil. Of that sample, 330 (74%) subjects died from violent deaths and 116 (26%) died naturally. The presence of biliary calculi, previous cholecystectomy, gender, age, ethnicity, body mass index (BMI) and alcohol use were evaluated.
  
  
  RESULTS
  In the natural death group, 6.9% (95% CI 3.39 to 13.28) (3.08% of the male subjects and 11.76% of the female subjects) exhibited evidence of gallbladder disease. In the violent death group, only 2.12% (95% CI 0.96 to 4.43) (2.17% of the male subjects and 1.85% of the female subjects) of the subjects exhibited evidence of gallbladder disease. Age was correlated with the prevalence of gallbladder disease, but BMI was correlated with only gallbladder disease in the natural death group.
  
  
  CONCLUSIONS
  This population has the lowest prevalence of cholelithiasis in the Americas. Dietary habits, physical activity, ethnicity, alcohol consumption and genetic factors may be responsible for this low prevalence.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brasil.
authors.forename: André Marangoni
authors.initials: AM
authors.lastname: Asperti
authors.affiliation: Faculdade de Medicina da Universidade Federal do Tocantins, Departamento de Cirurgia, Departamento de Medicina Forense e Digestivo, Palmas/TO, Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Reis
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brasil.
authors.forename: Marcio Augusto
authors.initials: MA
authors.lastname: Diniz
authors.affiliation: Faculdade de Medicina da Universidade Federal do Tocantins, Departamento de Cirurgia, Departamento de Medicina Forense e Digestivo, Palmas/TO, Brasil.
authors.forename: Mariana Dourado
authors.initials: MD
authors.lastname: Pinto
authors.affiliation: Faculdade de Medicina da Universidade Federal do Tocantins, Departamento de Cirurgia, Departamento de Medicina Forense e Digestivo, Palmas/TO, Brasil.
authors.forename: Edinésio Carlos da
authors.initials: EC
authors.lastname: Silva
authors.affiliation: Faculdade de Medicina da Universidade Federal do Tocantins, Departamento de Cirurgia, Departamento de Medicina Forense e Digestivo, Palmas/TO, Brasil.
authors.forename: Danilo Felipe Dias da
authors.initials: DF
authors.lastname: Silva
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brasil.
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brasil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking; D000569:Americas / Q000453:epidemiology; D001344:Autopsy; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002769:Cholelithiasis / Q000453:epidemiology* / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D018709:Statistics, Nonparametric