title: Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI.
abstract: BACKGROUND
  Obesity is a well-established risk factor for cholelithiasis. But most of the studies have actually tried to establish the risk of cholelithiasis in overweight and obese people. Very few studies have addressed the issue of cholelithiasis in patients with otherwise normal Body Mass Index (BMI). In this study we have tried to establish if there is any relationship between increasing BMI and cholelithiasis.
  
  
  OBJECTIVE
  To establish a relationship between increasing BMI and risk of cholelithiasis.
  
  
  METHODS
  Retrospective analysis was carried out after doing a prospective pilot study. Ten years data of patients admitted to surgery ward with complaints of pain abdomen was reviewed. Patients with cholelithiasis were segregated as cases and patients with some other diagnosis were selected as controls. Patients with incidental diagnosis of cholelithiasis were excluded. Appropriate analytical tools were used to draw the results using SPSS©20.
  
  
  RESULTS
  Over 11,000 patients data was reviewed and 7,182 patients were selected for inclusion into the study. Major exclusion was due to incomplete availability of data. Cholelithiasis group had 2,872 patients and rest of the patients served as controls against them. Female patients outnumbered their male counterparts in cholelithiasis group. Mean age of the gallstone patients was 37.09 years, almost 2 years younger than their controls. Mean BMI of all patients was 23.55 kg/m2and in cholelithiasis and control group was 24.93 and 22.62, respectively (df=1, F>1635.395, p<0.001). Gender specific comparison also yielded a significant difference df=3, F=547.238, p<0.001). The difference in the way the patients were distributed among the ethnic groups (Nepalis, Bhutias, Lepchas and others) was also significant (df=3, F=34.234, p<0.001). Most important outcome was that the majority of the patients in the cholelithiasis group were within the normal BMI range.
  
  
  CONCLUSIONS
  We concluded that it's not only the overweight or obese patients who develop symptomatic cholelithiasis but also the individuals with normal BMI. The risk of symptomatic cholelithiasis increases with every increase in BMI. Risk of symptomatic cholelithiasis also increases in women and as the age advances.
authors.affiliation: Associate Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Bikram
authors.initials: B
authors.lastname: Kharga
authors.affiliation: Associate Professor, Department of Radiology, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Barun Kumar
authors.initials: BK
authors.lastname: Sharma
authors.affiliation: Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Varun Kumar
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Associate Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Kumar
authors.initials: K
authors.lastname: Nishant
authors.affiliation: Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Phuchungla
authors.initials: P
authors.lastname: Bhutia
authors.affiliation: Assistant Professor, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Roshan
authors.initials: R
authors.lastname: Tamang
authors.affiliation: Senior Resident, Department of Surgery, Sikkim Manipal Institute of Medical Sciences , Sikkim, Gangtok, India .
authors.forename: Nitin
authors.initials: N
authors.lastname: Jain
keywords: Cholecystectomy; Gall bladder; Gallstones