Ninevah Journal of Public Health & Nursing
Online ISSN:1234-5678

Prevalence and Associated Risk Factors of Cholecystitis Among Adult Patients in Ranya City, Iraq: A Cross-Sectional Study

Document Type : Original Article

Authors

Shilan Muhammad Abdulbaqi
Barzan Mohammed M.Ameen

College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012 Iraq

10.64554/njphn.2026.192113
Abstract
Background: Cholecystitis is a common inflammatory disease of the gallbladder, most frequently resulting from gallstone obstruction of the cystic duct. It remains an important cause of hospital admission and emergency abdominal surgery worldwide. Several demographic, metabolic, and lifestyle factors have been implicated in its development; however, local evidence from Iraq remains limited.
Objective: To determine the demographic and lifestyle factors associated with cholecystitis among adult patients in Ranya City, Iraq.
Methods: A descriptive cross-sectional study was conducted among 240 patients diagnosed with cholecystitis who attended four public and private healthcare facilities in Ranya City between November 23, 2024, and March 3, 2025. Participants were recruited using a purposive sampling technique. Data were collected using a researcher-developed questionnaire validated by a panel of 15 experts. The instrument demonstrated acceptable internal consistency (Cronbach's α = 0.80). Data were analyzed using SPSS version 27. Descriptive statistics and Chi-square tests were used to examine associations, with statistical significance established at p < 0.05.
Results: The mean age of participants was 42.68 ± 12.53 years, and 78.8% were female. Most participants were married (88.3%), overweight (45.4%), unemployed (68.8%), and non-smokers (92.5%). Frequent consumption of high-fat foods, caffeinated beverages, and limited physical activity were common lifestyle characteristics. Significant associations were identified between educational level and high-fat diet (p = 0.002), caffeinated beverage consumption (p = 0.001), and regular physical activity (p = 0.003). Body mass index was significantly associated with high-fat dietary intake (p = 0.040), caffeinated beverage consumption (p < 0.001), and physical activity (p = 0.020). Gender was also significantly associated with caffeinated beverage consumption (p = 0.010).
Conclusion: Female sex, overweight and obesity, unhealthy dietary habits, frequent caffeinated beverage consumption, and physical inactivity were common among patients with cholecystitis. Educational level and body mass index were significantly associated with several modifiable lifestyle factors, highlighting the importance of targeted health education and lifestyle interventions to reduce the burden of cholecystitis.

Keywords

Cholecystitis
Gallbladder disease
Risk factors
Lifestyle factors
Obesity
Cross-sectional study
Crossmark

INTRODUCTION

Cholecystitis is an inflammatory disorder of the gallbladder that most commonly results from obstruction of the cystic duct by gallstones. It represents one of the most frequent gastrointestinal emergencies requiring hospitalization and surgical intervention worldwide. Acute cholecystitis accounts for a substantial proportion of emergency abdominal admissions and, if left untreated, may progress to serious complications including gangrene, perforation, abscess formation, and sepsis [1,2].

Gallstone disease affects approximately 10–15% of adults globally, although prevalence varies considerably according to geographic location, ethnicity, dietary habits, and lifestyle characteristics. While many individuals with gallstones remain asymptomatic throughout their lives, approximately 10–20% eventually develop symptomatic disease, with acute cholecystitis being the most common complication [3,4]. Advances in diagnostic imaging, particularly abdominal ultrasonography, have improved early diagnosis, enabling timely treatment and reducing disease-related morbidity [2].

The pathophysiology of cholecystitis involves persistent obstruction of the cystic duct, usually by cholesterol gallstones, leading to increased intraluminal pressure, impaired gallbladder drainage, ischemia, bacterial proliferation, and inflammation of the gallbladder wall [5]. Less commonly, acute acalculous cholecystitis occurs in critically ill patients without gallstones and is associated with trauma, severe infections, prolonged fasting, or systemic diseases [6].

Several demographic, metabolic, and lifestyle factors have been identified as contributors to gallstone formation and the subsequent development of cholecystitis. Female sex, increasing age, obesity, pregnancy, diabetes mellitus, dyslipidemia, rapid weight loss, and a positive family history are well-established risk factors [3,7]. Lifestyle-related behaviors, including excessive consumption of high-fat diets, low dietary fiber intake, physical inactivity, and sedentary lifestyles, further increase the risk by promoting cholesterol supersaturation of bile and impaired gallbladder motility [8,9].

Obesity has consistently been recognized as one of the strongest modifiable risk factors for gallbladder disease. Increased body mass index (BMI) is associated with enhanced hepatic cholesterol secretion, resulting in cholesterol crystal formation and gallstone development. Similarly, diets rich in saturated fats and refined carbohydrates, combined with inadequate physical activity, contribute to metabolic disturbances that increase susceptibility to gallbladder disease [9,10]. Conversely, regular exercise and healthy dietary practices improve lipid metabolism, enhance gallbladder emptying, and reduce the risk of gallstone formation [3].

Although the epidemiology and risk factors of cholecystitis have been extensively investigated in developed countries, evidence from Iraq remains limited. Previous Iraqi studies have demonstrated that female sex, obesity, and metabolic disorders are common among patients with gallstone disease; however, few studies have comprehensively evaluated dietary habits, caffeinated beverage consumption, smoking, and physical activity as modifiable risk factors in patients with cholecystitis [11,12]. Understanding these factors is essential for developing preventive strategies and promoting healthier lifestyles among high-risk populations.

Therefore, this study aimed to assess cholecystitis and identify demographic and lifestyle-related factors among patients attending public and private healthcare facilities in Ranya City, Iraq. The findings are expected to provide evidence that can support preventive health education, encourage lifestyle modification, and contribute to reducing the burden of gallbladder disease in the region.

MATERIALS AND METHODS

Study Design

A quantitative descriptive cross-sectional study was conducted to assess cholecystitis and identify demographic and lifestyle-related factors among adult patients diagnosed with the disease.

Study Setting

The study was carried out at four healthcare facilities in Ranya City, Sulaymaniyah Governorate, Kurdistan Region, Iraq, including Ranya General Hospital, Kurdistan Private Hospital, Shahid Ahmed Ismail Hospital, and Ranya Medical Clinics. Data collection was conducted between 23 November 2024 and 3 March 2025.

Study Population and Sampling

The study population comprised adult patients diagnosed with cholecystitis who attended the selected healthcare facilities during the study period. A total of 240 patients were recruited using a non-probability purposive sampling technique.

Inclusion Criteria

Participants were eligible if they:

  • Were diagnosed with acute or chronic cholecystitis by a specialist physician.
  • Were aged 20 years or older.
  • Attended one of the selected hospitals or clinics during the study period.
  • Were able to communicate and respond to the interview questions.
  • Agreed to participate and provided informed consent.

Exclusion Criteria

Patients were excluded if they:

  • Had severe cognitive impairment or communication difficulties.
  • Were critically ill and unable to participate in the interview.
  • Declined participation in the study.
  • Submitted incomplete questionnaires.

Study Instrument

Data were collected using a structured questionnaire developed after an extensive review of the relevant literature. The questionnaire consisted of four sections:

  • Part I: Socio-demographic characteristics, including age, sex, body mass index (BMI), educational level, marital status, occupation, residence, and smoking status.
  • Part II: Dietary habits, including consumption of fruits, vegetables, grains, proteins, seafood, dairy products, fast foods, high-fat diets, reading nutrition labels, and adherence to dietary regimens.
  • Part III: Beverage consumption, including caffeinated beverages, frequency and quantity of caffeine intake, timing of caffeine consumption, energy drink consumption, and alcohol intake.
  • Part IV: Physical activity, including regular exercise, incorporation of physical activity into daily routines, and preferred types of exercise.

Validity and Reliability

Content validity of the questionnaire was established by a panel of 15 experts in nursing and medical sciences. Following expert review, necessary modifications were incorporated into the final version. Reliability testing demonstrated satisfactory internal consistency with a Cronbach's alpha coefficient of 0.80, indicating good reliability of the instrument.

Data Collection Procedure

Eligible patients were identified during their visits to the participating hospitals and clinics. After explaining the study objectives and obtaining written informed consent, participants completed face-to-face interviews conducted by the researcher. Each interview required approximately 15–20 minutes to complete. Anthropometric and demographic information was obtained directly from participants and verified through medical records when available.

Ethical Considerations

Ethical approval was obtained from the Scientific and Ethical Committee of the College of Nursing, University of Raparin before commencing the study. Official permission was also obtained from the participating healthcare institutions. Participation was voluntary, and written informed consent was obtained from all participants. Confidentiality and anonymity were maintained throughout the study by assigning identification codes instead of participants' names. Participants were informed that they could withdraw from the study at any stage without any consequences.

Statistical Analysis

Data were coded, entered, and analyzed using the Statistical Package for the Social Sciences (SPSS), version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, standard deviations, minimum and maximum values, were used to summarize the data. Associations between socio-demographic characteristics and lifestyle-related factors were examined using the Chi-square test. A p-value < 0.05 was considered statistically significant.

RESULTS

A total of 240 patients diagnosed with cholecystitis participated in this study. The mean age of the participants was 42.68 ± 12.53 years (range: 20–87 years). The largest proportion (31.3%) belonged to the 40–49-year age group, followed by those aged 30–39 years (28.7%). Females constituted the majority of the study population (78.8%), while males accounted for 21.3%. Most participants were married (88.3%), unemployed (68.8%), and resided in suburban areas (49.6%). Regarding body mass index (BMI), 45.4% of participants were overweight and 35.0% were obese. More than one-quarter (25.8%) were illiterate, and the majority (92.5%) were non-smokers (Table 1).

The dietary habits of the participants are summarized in Table 2. Most participants reported regular consumption of fruits (97.5%), dairy products (86.7%), grains (79.6%), vegetables (73.3%), and proteins (72.9%). Conversely, unhealthy dietary behaviors were common; 50.8% occasionally consumed fast food, while 41.6% frequently consumed high-fat diets. Furthermore, 63.8% never read nutritional labels when purchasing food, and 62.5% reported never following a specific dietary regimen, indicating poor adherence to healthy eating practices (Table 2).

Table 3 presents participants' beverage consumption patterns. The majority (83.3%) consumed caffeinated beverages such as tea or coffee, with 44.2% reporting frequent consumption. More than half (54.6%) consumed more than two cups of caffeinated beverages daily, and 53.3% reported drinking caffeine during late-night hours. Most participants (58.8%) never consumed energy drinks, and none reported alcohol consumption (Table 3).

Regarding physical activity, only 12.9% of participants reported engaging in regular exercise, whereas 87.1% were physically inactive. Similarly, only 29.4% incorporated physical activities such as walking or cycling into their daily routine. Sports-related activities were the most frequently reported form of exercise (7.1%), followed by cardiovascular exercise (6.7%) and strength training (3.8%). However, 82.5% reported not participating in any structured exercise program (Table 4).

The associations between socio-demographic characteristics and lifestyle-related factors are presented in Table 5. Gender was significantly associated with caffeinated beverage consumption (χ² = 13.3, p = 0.010), whereas no significant association was observed between gender and either high-fat dietary intake or regular exercise. Body mass index demonstrated significant associations with high-fat dietary intake (χ² = 4.53, p = 0.040), caffeinated beverage consumption (χ² = 6.19, p < 0.001), and regular exercise (χ² = 4.85, p = 0.020). Educational level was also significantly associated with high-fat dietary intake (χ² = 35.37, p = 0.002), caffeinated beverage consumption (χ² = 41.25, p = 0.001), and regular physical activity (χ² = 26.72, p = 0.003). In contrast, age showed no statistically significant association with any of the investigated lifestyle factors (all p > 0.05) (Table 5).

Table 1. Socio-demographic characteristics of patients with cholecystitis (N = 240)

Variable Category n %
Age group (years) 20–29 35 14.6
  30–39 69 28.7
  40–49 75 31.3
  50–59 39 16.3
  ≥60 22 9.2
Age (years) Mean ± SD 42.68 ± 12.53  
Sex Male 51 21.3
  Female 189 78.8
Body Mass Index Underweight 4 1.7
  Normal weight 33 13.8
  Overweight 109 45.4
  Obese 84 35.0
Educational level Illiterate 62 25.8
  Read & write 52 21.7
  Primary school 44 18.3
  Secondary school 22 9.2
  High school 28 11.7
  Institute/College 32 13.3
Marital status Single 20 8.3
  Married 212 88.3
  Divorced 8 3.3
Occupation Employed 46 19.2
  Unemployed 165 68.8
  Self-employed 29 12.1
Residence Urban 101 42.1
  Suburban 119 49.6
  Rural 20 8.3
Smoking Yes 18 7.5
  No 222 92.5

Table 2. Dietary habits among patients with cholecystitis (N = 240)

Dietary habit Always n (%) Frequently n (%) Occasionally n (%) Rarely n (%) Never n (%)
Eating fruits 234 (97.5) 6 (2.5) 0 0 0
Eating vegetables 176 (73.3) 58 (24.2) 6 (2.5) 0 0
Eating grains 191 (79.6) 40 (16.7) 8 (3.3) 1 (0.4) 0
Eating proteins/red meat 175 (72.9) 59 (24.6) 6 (2.5) 0 0
Eating seafood 78 (32.5) 61 (25.4) 72 (30.0) 29 (12.1) 0
Eating dairy products 208 (86.7) 30 (12.5) 2 (0.8) 0 0
Eating fast food 0 58 (24.2) 122 (50.8) 44 (18.3) 16 (6.7)
Eating high-fat diet 21 (8.8) 100 (41.6) 81 (33.8) 35 (14.6) 3 (1.2)
Reading nutrition labels 0 30 (12.5) 27 (11.3) 30 (12.5) 153 (63.8)
Following dietary regimen 0 5 (2.1) 34 (14.2) 51 (21.3) 150 (62.5)

Table 3. Beverage consumption patterns among patients with cholecystitis (N = 240)

Variable Category n %
Consume caffeinated beverages Yes 200 83.3
  No 40 16.7
Frequency of caffeine intake Always 40 16.7
  Frequently 106 44.2
  Occasionally 42 17.5
  Rarely 40 16.7
  Never 12 5.0
Daily caffeine consumption ≥5 cups 54 22.5
  >2 cups 131 54.6
  <2 cups 43 17.9
  None 12 5.0
Preferred time for caffeine Morning 9 3.8
  Afternoon 32 13.3
  Evening 71 29.6
  Late night 128 53.3
Energy drink consumption Regularly 66 27.5
  Occasionally 18 7.5
  Daily 15 6.3
  Never 141 58.8
Alcohol consumption Yes 0 0.0
  No 240 100.0

Table 4. Physical activity among patients with cholecystitis (N = 240)

Variable Category n %
Regular exercise Yes 31 12.9
  No 209 87.1
Physical activity in daily routine Yes 71 29.4
  No 169 70.6
Preferred type of exercise Cardiovascular 16 6.7
  Strength training 9 3.8
  Sports 17 7.1
  None 198 82.5

Table 5. Association between socio-demographic characteristics and selected lifestyle-related factors among patients with cholecystitis (N = 240)

Variable High-fat diet p Caffeinated beverages p Regular exercise p
Sex 0.130 0.010 0.410
Age group 0.700 0.530 0.130
Body mass index 0.040 <0.001 0.020
Educational level 0.002 0.001 0.003

Chi-square test; statistically significant at p < 0.05.

DISCUSSION

The present study investigated the demographic and lifestyle-related factors associated with cholecystitis among patients attending healthcare facilities in Ranya City, Iraq. The findings revealed that female sex, overweight and obesity, unhealthy dietary behaviors, frequent caffeinated beverage consumption, and physical inactivity were common among patients with cholecystitis. Furthermore, educational level and body mass index were significantly associated with several modifiable lifestyle factors, highlighting the importance of preventive health education and lifestyle interventions.

The majority of participants in the present study were women (78.8%), which is consistent with previous epidemiological studies demonstrating that gallbladder disease occurs more frequently in females than males [1–3]. Female predominance has been attributed to the influence of estrogen and progesterone, which increase biliary cholesterol secretion while reducing gallbladder contractility, thereby promoting cholesterol gallstone formation [4]. Similar findings have been reported in Iraqi and international studies, where women represented approximately 56%–72% of patients diagnosed with cholecystitis or gallstone disease [2,5]. This finding further supports the well-established association between female sex and gallbladder disorders.

Obesity was another prominent characteristic observed in the present study, with more than four-fifths of participants being either overweight or obese. This observation agrees with previous investigations that identified increased body mass index as one of the strongest modifiable risk factors for gallstone disease and cholecystitis [6–8]. Excess adiposity contributes to cholesterol supersaturation of bile, impaired gallbladder emptying, insulin resistance, and metabolic syndrome, all of which facilitate gallstone formation. Consequently, obesity remains an important target for preventive interventions aimed at reducing the burden of gallbladder disease.

Dietary assessment demonstrated that although participants reported frequent consumption of fruits, vegetables, dairy products, and grains, unhealthy eating behaviors remained highly prevalent. Approximately half of the participants occasionally consumed fast food, more than two-fifths frequently consumed high-fat meals, and nearly two-thirds never followed dietary recommendations or read nutritional labels. These findings are consistent with previous studies indicating that diets rich in saturated fats and cholesterol increase the likelihood of gallstone formation, whereas diets rich in fiber, fruits, and vegetables exert protective effects [3,7]. The persistence of unhealthy dietary habits among patients diagnosed with cholecystitis emphasizes the need for individualized nutritional counseling as part of routine clinical care.

The present study also demonstrated that caffeinated beverage consumption was common, with more than four-fifths of participants consuming tea or coffee regularly and over half drinking more than two cups daily. Interestingly, gender, body mass index, and educational level were significantly associated with caffeine consumption. Although previous studies have produced conflicting evidence regarding the relationship between caffeine intake and gallbladder disease, several investigations suggest that moderate coffee consumption may stimulate gallbladder contraction and reduce cholesterol crystallization, whereas excessive or unhealthy beverage consumption may reflect broader lifestyle patterns associated with metabolic disorders [9,10]. Therefore, caffeine intake should be interpreted within the context of overall dietary and lifestyle behaviors rather than as an isolated risk factor.

Physical inactivity was highly prevalent among the participants, with only 12.9% engaging in regular exercise. This finding is comparable to previous reports indicating that sedentary behavior contributes to obesity, insulin resistance, dyslipidemia, and impaired gallbladder motility, thereby increasing the risk of gallstone disease [6,11]. Regular physical activity improves lipid metabolism, enhances insulin sensitivity, promotes gallbladder emptying, and reduces biliary cholesterol saturation, all of which decrease the likelihood of gallstone formation. These findings support current recommendations encouraging routine exercise as an essential component of gallbladder disease prevention.

Educational level demonstrated significant associations with dietary habits, caffeinated beverage consumption, and regular physical activity. Participants with higher educational attainment generally reported healthier lifestyle behaviors than those with lower educational levels. Similar associations have been reported in studies evaluating chronic disease prevention, where education improves health literacy, awareness of disease risk factors, and adoption of healthy behaviors [12]. These findings suggest that educational interventions may play an important role in reducing modifiable risk factors for cholecystitis.

Body mass index was also significantly associated with unhealthy dietary intake, caffeinated beverage consumption, and physical inactivity. This finding reinforces the complex interaction between obesity and lifestyle behaviors in the development of gallbladder disease. Previous studies have consistently shown that obesity is not only an independent risk factor but also closely linked to unhealthy dietary patterns and sedentary lifestyles that accelerate gallstone formation [6–8].

The present study has several strengths. It included a relatively large sample recruited from multiple healthcare facilities and comprehensively evaluated demographic characteristics together with dietary habits, beverage consumption, and physical activity. Furthermore, the study employed a validated questionnaire with acceptable reliability, providing a comprehensive assessment of modifiable lifestyle-related factors.

However, several limitations should be acknowledged. The cross-sectional design prevents determination of causal relationships between risk factors and cholecystitis. The purposive sampling technique may limit the generalizability of the findings to other populations. In addition, dietary habits and physical activity were self-reported, making them susceptible to recall and social desirability bias. Finally, biochemical indicators such as serum lipid profiles and detailed clinical severity measures were not evaluated, which may have provided further insight into disease mechanisms.

Overall, the findings emphasize that lifestyle-related factors remain important determinants of cholecystitis. Public health strategies focusing on weight management, healthy dietary practices, increased physical activity, and targeted educational programs may substantially reduce the burden of gallbladder disease among high-risk populations.

Limitations of the Study

This study has several limitations that should be considered when interpreting its findings. First, the cross-sectional design precludes establishing causal relationships between demographic and lifestyle factors and the development of cholecystitis. Second, participants were recruited using a purposive sampling technique from healthcare facilities within a single city, which may limit the generalizability of the findings to other regions of Iraq. Third, dietary habits, beverage consumption, and physical activity were assessed using self-reported data, making the results susceptible to recall and social desirability bias. Finally, important clinical and biochemical variables, such as serum lipid profiles, diabetes status, and gallstone characteristics, were not evaluated, which may have provided a more comprehensive understanding of the factors associated with cholecystitis.

Conclusion

The present study demonstrated that cholecystitis was more frequently observed among female and overweight or obese patients. Unhealthy lifestyle behaviors, including frequent consumption of high-fat diets, regular caffeinated beverage intake, and low levels of physical activity, were common among the study population. Educational level and body mass index were significantly associated with several modifiable lifestyle factors, suggesting that socioeconomic and behavioral characteristics influence the risk profile of patients with cholecystitis. These findings underscore the importance of promoting healthy dietary practices, regular physical activity, weight management, and targeted health education to reduce the burden of cholecystitis and support the development of effective prevention strategies in clinical and community settings.

 
 
 

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Ninevah Journal of Public Health & Nursing
Volume 1, Issue 1
Summer 2026

  • Receive Date 03 March 2025
  • Revise Date 13 April 2026
  • Accept Date 05 July 2026
  • First Publish Date 22 July 2026
  • Publish Date 01 August 2026

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