Children are increasingly suffering from gallstones, traditionally thought of as a problem confined to adults, because they are becoming so overweight, a study has found.
Doctors have found obese children are up to eight times more likely than those of a healthy weight to be diagnosed with gallstones, which can cause excruciating pain.
Researchers said that although gallstones were “historically rare” in adolescents, doctors were seeing more cases in that age group.
It was adding to an “alarming trend” of youngsters presenting with conditions usually only seen in adults, they warned.
The American academics, from private insurer Kaiser Permanente, looked at the incidence of gallstones in over 500,000 Californian children aged 10 to 19.
They found girls who were extremely obese were eight times more likely than their healthy-weight female classmates to be diagnosed with gallstones. Those who were merely obese were at a six-fold greater risk.
Gallstones are crystal-like masses that typically form in the gallbladder. The gallbladder is a small organ located on the right side of the abdomen, just below the liver. The gallbladder’s main function is to store bile (made by the liver) and secrete it into the small intestine to help digestion. Bile is made of water, cholesterol, fats, bile salts (natural detergents that break up fat), and a pigment called bilirubin. Gallstones form if the bile contains too much cholesterol, bile salts, or bilirubin.
There are two types of gallstones. Cholesterol stones contain mostly hardened cholesterol and account for approximately 80% of gallstones. Pigment stones are made of bilirubin and account for the other 20%. Gallstones can range in size from very small to as large as a golf ball. The gallbladder may develop any number and size of stones.
Gallstones are more common in women and people who are older, as well as in certain groups of people, such as people of First Nations descent and people who are overweight. In the United States, 20% of people over the age of 65 have gallstones, but most never experience symptoms. However, complications from gallstones can be serious if symptomatic stones are left untreated.
Among boys the link was weaker: the extremely obese had triple the chance of developing them and the obese were at almost double the risk.
Children who were overweight, but not obese, also had a higher incidence of gallstones. Among boys, being overweight increased the risk by almost 50 per cent, while it almost tripled the risk in girls.
Four out of five gallstones are caused by unusually high levels of cholesterol in the gallbladder, according to the NHS Choices website. This excess cholesterol “gradually solidifies to form a stone”. A minority are caused by high levels of bilirubin - broken down red blood cells. They can be as big as golf balls, although most are much smaller.
Prevalence of gallstones in obese Caucasian American women
Although the association between gallstones and obesity is well known, no attempt has been made to quantitate the increased risk for gallstone formation associated with moderate obesity commonly seen in clinical practice. To determine the prevalence of both asymptomatic and symptomatic gallstones, screening oral cholecystograms were combined with prior documented history in 249 consecutive obese Caucasian women aged 20-59 yr who were seeking treatment for obesity in an out-patient clinic. To ascertain the relative risk of moderate obesity for gallstone formation, the results were compared with a control group of 60 consecutive women who were undergoing screening health examinations in the same clinic. Both groups were without gastrointestinal symptoms. Gallstone prevalence averaged 31 percent among obese women compared to 10 percent in the control group. Sixty percent of gallstones in the combined 20-29 yr age group were asymptomatic. However, among all patients with gallstone disease 59 percent had symptomatic disease evidence by prior cholecystectomy. Moderate obesity imposes at least a three-fold risk of gallstone disease in Caucasian women.
What is the relation between obesity and gallstones? Gallstones are more likely to form in individuals who are obese and less likely to form in persons of normal healthy weight. Formation of gallstones in obese women has higher probability than men. Studies have shown that cholesterol levels are elevated in obese persons. This result in bile production and this is a strong source of excess cholesterol that is unable to be dissolved. From this gallstones are usually formed. Also obese persons often times have gallbladders that will never empty in a normal manner if at all.
Some studies have also shown that persons with excess stomach fat are more than likely to develop gallstones than persons who have excess fat on their hip area. When your BMI goes up your chances of developing gallstones goes up too. Women whose BMI is over 32 are three times more likely to end up having gallstones than those who have a BMI of 25.
Tucker LE, Tangedahl TN, Newmark SR.
Int J Obes. 1982;6(3):247-51.
Symptoms can include recurrent abdominal pain and nausea. They can block the passage of bile into the intestine, which can cause severe damage or infection in the gallbladder, liver, or pancreas. If left untreated, the condition can be fatal.
It is well known that being an obese adult markedly increases the risk of gallstones, but Corinna Koebnick, lead author of the study, said the fact they were appearing in children was of concern.
She said: “Although gallstones are relatively common in obese adults, gallstones in children and adolescents have been historically rare.
“These findings add to an alarming trend - youth who are obese or extremely obese are more likely to have diseases we normally think of as adult conditions.”
She went on: “We are also seeing more and more frequently among adolescents is diabetes, hypertension and High cholesterol.”
Symptoms of gallstones
Have a quick look at the symptoms of gallstones causing gallbladder attack. This attack is due to the blockage in the gallbladder caused by gallstones. Such attack occurs unexpectedly or after having heavy meals at night. However they may not show any symptoms in the initial stage or when they are very small. In such case gallstone is referred as ‘silent stone’.
- Prolonged abdominal pain
- Gas, nausea and bloating
- Pain in upper and middle abdomen
- Pain in right shoulder blade
- Fever accompanied by pain