Gallstone Formation During Weight-Reduction Dieting

doi:10.1001/archinte.1989.00390080036009

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Vol. 149 No. 8, August 1989

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Gallstone Formation During Weight-Reduction Dieting

Rodger A. Liddle, MD; Ruth B. Goldstein, MD; Joan Saxton, MD

Arch Intern Med. 1989;149(8):1750-1753.

Abstract

• We investigated the development of gallstones over an8-week period from the onset of dieting in 51 obese men andwomen and 26 nondieting control subjects. Gallbladder examinationswere performed by abdominal real-time ultrasonography for thedetection of gallstones. Initial sonography was performed priorto dieting and only those subjects in whom initial sonogramsshowed no gallstones or sludge were included in the study. Repeatedsonography was performed at 4-week intervals for 8 weeks whilethey remained on a 2100-kJ/d diet. Initial weight of subjectsprior to dieting averaged 105.9 ± 3.8 kg (162% of idealbody weight) and decreased to 89.4 ± 3.2 kg (137.3% ofideal body weight) after 8 weeks of dieting. Sonography performedafter 4 weeks of dieting revealed new-onset gallbladder sludgein 1 subject and gallstones in 4 subjects. After 8 weeks ofdieting sludge was detected in 3 subjects and gallstones in13(25.5%). In contrast, none of the nondieting subjects developedany detectable gallbladder abnormalities. During the dietingperiod, 1 of 51 subjects developed symptoms of biliary colic,necessitating cholecystectomy. On cessation of dieting withreinstitution of normal feeding, 2 additional subjects withstones developed symptoms severe enough to require cholecystectomy.In all 3 cases, cholesterol gallstones were recovered at thetime of surgery. Eleven of the 13 patients with gallstones werefollowed up for 6 months after discontinuation of the diet.Besides the 3 undergoing cholecystectomy, 4 subjects had gallstoneson follow-up ultrasound examination, while sonographically detectablegallstones had disappeared in 4 subjects. We conclude that thisform of weight-reduction dieting predisposes to the developmentof gallstones and that gallstone formation is a risk of thistype of prolonged calorie restriction. Dissolution or evacuationof gallstones may occur with resumption of a normal diet.

(Arch Intern Med. 1989;149:1750-1753)

Author Affiliations

From the Cell Biology Laboratory and Department of Medicine, Mount Zion Hospital and Medical Center (Dr Liddle); the Departments of Medicine (Dr Liddle) and Radiology (Dr Goldstein), University of California, San Francisco; and the Department of Medicine, Children's Hospital, San Francisco, Calif (Dr Saxton). Dr Liddle is now with the Department of Medicine, Duke University Medical Center, Durham, NC.

Footnotes

Accepted for publication March 14, 1989.

Reprint requests to Department of Medicine, PO Box 3083, DukeUniversity Medical Center, Durham, NC 27710 (Dr Liddle).

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