Given that cholesterol gallstone disease is a metabolic problem, it should correlate with lipid abnormalities, diabetes mellitus, and adiposity. Although most gallstones in the Western world consist of cholesterol, there is no definite association with hypercholesterolemia.1 Rather, a low HDL cholesterol carries an increased risk of developing stones, as does hypertriglyceridemia.
The association between diabetes mellitus and gallstones is confounded by age, obesity, and a family history of gallstones.1 The link between diabetes, obesity, and gallstones most likely comes through the metabolic syndrome. The metabolic syndrome characterizes a specific body phenotype (abdominal obesity), insulin resistance (type 2 diabetes mellitus), and dyslipidemia (hypertriglyceridemia), all risks for cardiovascular disease. Insulin resistance predisposes to cholesterol gallstone disease,28,29 suggesting that hepatic insulin resistance must somehow affect cholesterol and bile salt metabolism.
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