Insulin Resistance Causes Human Gallbladder Dysmotility

Attila Nakeeb, Anthony G. Comuzzie, Hayder Al-Azzawi, Gabriele E. Sonnenberg, Ahmed H. Kissebah, Henry A. Pitt

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Obesity, diabetes, and hyperlipidemia are known risk factors for the development of gallstones. A growing body of animal and human data has correlated insulin resistance with organ dysfunction. The relationship among obesity, diabetes, hyperlipidemia, and abnormal gallbladder motility remains unclear. Therefore, we designed a study to investigate the association among obesity, insulin resistance, hyperlipidemia, and gallbladder dysmotility. One hundred ninety-two healthy adult nondiabetic volunteers were studied. Gallbladder ultrasounds were performed before and after a standardized fatty meal. A gallbladder ejection fraction (EF) was calculated, and an EF of <25% was considered abnormal. Serum was analyzed for cholesterol, triglycerides, cholecystokinin, leptin, glucose, and insulin. The homeostasis assessment model (HOMA) was used to determine insulin resistance. The volunteers had a mean age of 38 years (range, 18-77), and 55% were female. Thirty subjects (15%) had gallstones and were excluded from the study. Thirty subjects (19%) had abnormal gallbladder motility (EF <25%). In lean subjects (n = 96) fasting glucose was significantly increased in the 16 subjects with gallbladder EF <25% versus the 80 subjects with gallbladder EF >25% (109 ± 20 mg/dl versus 78 ± 2 mg/dl, P < 0.05). Similarly, the HOMA index was significantly greater in subjects with gallbladder EF <25% versus gallbladder EF >25% (3.3 ± 1.2 versus 2.0 ± 0.2, P < 0.05). In obese subjects (n = 66), fasting glucose, insulin, and insulin resistance were not associated with a gallbladder EF <25%. These data suggest that in lean, nondiabetic volunteers without gallstones, gallbladder dysmotility is associated with an elevated fasting glucose as well as a high index of insulin resistance. We conclude that insulin resistance alone may be responsible for gallbladder dysmotility that may result in acalculous cholecystitis or gallstone formation.

Original languageEnglish (US)
Pages (from-to)940-949
Number of pages10
JournalJournal of Gastrointestinal Surgery
Issue number7
StatePublished - Jul 2006


  • Insulin resistance
  • gallbladder motility
  • obesity

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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