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The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss.

Abstract

Obese persons are at risk for cholesterol gallstones because their bile is saturated with cholesterol. The risk increases during rapid weight loss by means of certain very-low-calorie diets or gastric bypass surgery. Gallstone risk factors during rapid weight loss include increased bile cholesterol saturation index and gallbladder stasis. Obese subjects were randomized to one of two low-calorie liquid diets for rapid weight loss: a 520-kcal diet with less than 2 g fat/d, and a 900-kcal diet with 30 g fat/d (including one 10-g fat meal to stimulate maximal gallbladder emptying). Bile and blood lipids, saturation index, leukocyte 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity, and ultrasonographic gallbladder emptying were measured repeatedly during dietary treatment. Both diets produced comparable weight loss of 22%. Bile cholesterol saturation index increased during both diets (26%), but fell to 15% below prediet level after weight loss. Compared with subjects' maximal gallbladder emptying fraction of 66%, the 520-kcal diet provided poor gallbladder emptying (35%), whereas the 10-g fat meal of the 900-kcal diet provided maximal emptying. Gallstones developed in four of six 520-kcal subjects and none of seven 900-kcal subjects (P = .021), an unanticipated difference that resulted in premature study termination for ethical reasons. Blood lipids and HMG CoA reductase activity in mononuclear leukocytes fell at week 8 during both diets, but recovered while weight was still being lost. The findings suggest that gallstone risk during rapid weight loss may be reduced by maintenance of gallbladder emptying with a small amount of dietary fat. Ultimately, weight loss reduced bile cholesterol saturation and improved highdensity lipoprotein (HDL) levels.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Minneapolis VA Medical Center, MN, USA.

    , , , , , ,

    Source

    Hepatology (Baltimore, Md.) 24:3 1996 Sep pg 544-8

    MeSH

    Adult
    Cholelithiasis
    Diet, Reducing
    Dietary Fats
    Female
    Gallbladder Emptying
    Humans
    Male
    Middle Aged
    Obesity
    Reference Values
    Time Factors
    Weight Loss

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    8781321

    Citation

    Gebhard, R L., et al. "The Role of Gallbladder Emptying in Gallstone Formation During Diet-induced Rapid Weight Loss." Hepatology (Baltimore, Md.), vol. 24, no. 3, 1996, pp. 544-8.
    Gebhard RL, Prigge WF, Ansel HJ, et al. The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss. Hepatology. 1996;24(3):544-8.
    Gebhard, R. L., Prigge, W. F., Ansel, H. J., Schlasner, L., Ketover, S. R., Sande, D., ... Peterson, F. J. (1996). The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss. Hepatology (Baltimore, Md.), 24(3), pp. 544-8.
    Gebhard RL, et al. The Role of Gallbladder Emptying in Gallstone Formation During Diet-induced Rapid Weight Loss. Hepatology. 1996;24(3):544-8. PubMed PMID: 8781321.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss. AU - Gebhard,R L, AU - Prigge,W F, AU - Ansel,H J, AU - Schlasner,L, AU - Ketover,S R, AU - Sande,D, AU - Holtmeier,K, AU - Peterson,F J, PY - 1996/9/1/pubmed PY - 1996/9/1/medline PY - 1996/9/1/entrez SP - 544 EP - 8 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 24 IS - 3 N2 - Obese persons are at risk for cholesterol gallstones because their bile is saturated with cholesterol. The risk increases during rapid weight loss by means of certain very-low-calorie diets or gastric bypass surgery. Gallstone risk factors during rapid weight loss include increased bile cholesterol saturation index and gallbladder stasis. Obese subjects were randomized to one of two low-calorie liquid diets for rapid weight loss: a 520-kcal diet with less than 2 g fat/d, and a 900-kcal diet with 30 g fat/d (including one 10-g fat meal to stimulate maximal gallbladder emptying). Bile and blood lipids, saturation index, leukocyte 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity, and ultrasonographic gallbladder emptying were measured repeatedly during dietary treatment. Both diets produced comparable weight loss of 22%. Bile cholesterol saturation index increased during both diets (26%), but fell to 15% below prediet level after weight loss. Compared with subjects' maximal gallbladder emptying fraction of 66%, the 520-kcal diet provided poor gallbladder emptying (35%), whereas the 10-g fat meal of the 900-kcal diet provided maximal emptying. Gallstones developed in four of six 520-kcal subjects and none of seven 900-kcal subjects (P = .021), an unanticipated difference that resulted in premature study termination for ethical reasons. Blood lipids and HMG CoA reductase activity in mononuclear leukocytes fell at week 8 during both diets, but recovered while weight was still being lost. The findings suggest that gallstone risk during rapid weight loss may be reduced by maintenance of gallbladder emptying with a small amount of dietary fat. Ultimately, weight loss reduced bile cholesterol saturation and improved highdensity lipoprotein (HDL) levels. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/8781321/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0270913996003679 DB - PRIME DP - Unbound Medicine ER -