Serum organochlorine pesticide residues and risk of gallstone disease: A case-control study in Xiamen
Introduction
Gallstone disease is a common digestive disease. The overall prevalence rate ranged from 3.9% to 13.7% before the development of ultrasonography as a diagnostic tool [1]. Several studies in China found that gallstone disease occurs in 5% to 11% of the population [2], [3], [4]. In Western countries, about 80% of gallstones are composed primarily of cholesterol [5], and about 50% of gallstones in China are cholesterol stones [6]. Epidemiologic and clinical investigations have suggested that estrogen plays an important role in cholesterol gallstone formation [7], [8].
Organochlorine pesticides (OCPs), such as dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH), have drawn attention because of their persistence in the environment, accumulation in adipose tissue of animals and humans, and slow elimination from the body, which have harmful effects on both the environment and humans [9], [10], [11]. The most prevalent metabolic product of DDT, dichlorodiphenyldichloroethylene (DDE), is ubiquitous in the environment and is found in various tissues of humans worldwide. DDE can be detected in the serum of more than 90% of the North American population [12] and is consistently found in follicular fluids and serum of women [13].
OCPs disrupt normal endocrine functions and are environmental endocrine disruptors (EEDs) at environmentally realistic exposure levels [14], [15], [16]. OCPs with various estrogenic-mimicking activities have been examined [17], [18]. Many studies have also been performed to investigate the relationship between estrogen and gallstones. Based on the hypothesis of the relationship between estrogen and gallstones, estrogenic-mimicking substances (e.g., OCPs) may be associated with gallstones. We hypothesized that OCPs are putative risk factors for gallstone development and that people with a history of occupational OCP exposure, high serum OCP levels, and consumption of OCP residues in food may bear a higher risk of gallstone formation. Xiamen City is located along China's southeast coast, where OCPs were once used much more heavily than in other areas of China [19] and still have limited production and use [20]. Therefore, this follow-up, hospital-based, case-control study investigated the association between the incidence of gallstones and the serum OCP residues in local Xiamen residents to better understand the pathogenesis of gallstones and provide a scientific basis for gallstone disease prevention.
Section snippets
Subject enrollment and questionnaire
A total of 150 patients with gallstones diagnosed by abdominal ultrasonography at Affiliated Chenggong Hospital of Xiamen University from June 2009 to June 2010 were collected. A 1:1, pair-matched, case-control study was designed. A total of 150 individuals without gallstones during the same period at the same hospital were matched with patients of the same gender and age (±2 years, with a ≤2-year difference) and included as the control group. The controls were screened for the absence of
General demographic characteristics of patients and controls
A total of 150 pairs of patients and controls were collected. The average age of patients was 48.71 years (standard error, 9.49), and that of controls was 48.35 years (standard error, 9.49). There was no difference in age distribution between patients and controls (t-test, t = 0.33; P = .7386). Single-factor conditional logistic regression analysis was conducted to identify the top 22 factors associated with gallstones; a history of cholecystitis (X4), frequent intake of soy products (X15),
Discussion
OCPs are ubiquitous and persistent organic pollutants. Because of their chemical characteristics, they have remained in environmental media worldwide at potentially harmful concentrations for many years. DDT, the most widely known pesticide, can undergo slow biodegradation in the environment through reductive dechlorination to form DDE and DDD. Once inside the human body, DDT can be further metabolized to DDE and DDD in the liver. DDT, DDE, and DDD are all lipid-soluble compounds and are
Acknowledgments
This work was supported by the Xiamen Municipal Science and Technology Program (3502Z20073015). The authors thank all who contributed their samples and work in this study. The authors thank Prof. Chengyi Qu (School of Public Health, Shanxi Medical College, P.R. China) for his assistance in improving the English and his helpful comments on the report.
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