初级预防始于胆结石预防。体力活动对结石病有一定的防护作用:相比于进行低水平体力活动的患者,胆石病患病率在进行中等程度体力活动的患者中下降,且与体质指数 (BMI) 无关。[20]Aune D, Leitzmann M, Vatten LJ. Physical activity and the risk of gallbladder disease: a systematic review and meta-analysis of cohort studies. J Phys Act Health. 2016 Jul;13(7):788-95.http://www.ncbi.nlm.nih.gov/pubmed/26901710?tool=bestpractice.com 两项队列研究表明,高纤维饮食摄入与症状性胆石病的发生率下降有关。[21]Ortega RM, Fernández-Azulea M, Encinas-Sotillos A, et al. Differences in diet and food habits between patients with gallstones and controls. J Am Coll Nutr. 1997 Feb;16(1):88-95.http://www.ncbi.nlm.nih.gov/pubmed/9013440?tool=bestpractice.com[22]Tsai CJ, Leitzmann MF, Willet WC, et al. Long-term intake of dietary fiber and decreased risk of cholecystectomy in women. Am J Gastroenterol. 2004 Jul;99(7):1364-70.http://www.ncbi.nlm.nih.gov/pubmed/15233680?tool=bestpractice.com 由于快速体重减轻和长期禁食与胆石形成高风险有关,将体重减轻限制为最多 1.5 kg/周(3.3 lb/周),以及在低卡路里饮食中添加 10 g (0.35 oz) 脂肪显示可预防胆结石形成。[21]Ortega RM, Fernández-Azulea M, Encinas-Sotillos A, et al. Differences in diet and food habits between patients with gallstones and controls. J Am Coll Nutr. 1997 Feb;16(1):88-95.http://www.ncbi.nlm.nih.gov/pubmed/9013440?tool=bestpractice.com[22]Tsai CJ, Leitzmann MF, Willet WC, et al. Long-term intake of dietary fiber and decreased risk of cholecystectomy in women. Am J Gastroenterol. 2004 Jul;99(7):1364-70.http://www.ncbi.nlm.nih.gov/pubmed/15233680?tool=bestpractice.com[23]Venneman NG, van Erpecum KJ. Gallstone disease: primary and secondary prevention. Best Pract Res Clin Gastroenterol. 2006;20(6):1063-73.http://www.ncbi.nlm.nih.gov/pubmed/17127188?tool=bestpractice.com 在无症状性和症状性胆结石患者中,使用亲水胆盐熊去氧胆酸治疗声称可降低胆道疼痛和胆结石并发症(如急性胆囊炎)风险。症状性胆结石患者进行胆囊切除术是最重要的预防策略。