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1 March 1996 | Volume 124 Issue 5 | Page 533
Shiffman and associates [1] used three different doses [300, 600, and 1200 mg] of UDCA and found 600 mg/d to be highly effective in preventing gallstone formation in patients receiving a very-low-calorie diet. We point out that 1) obesity is the major clinical factor associated with gallstone formation [2]; 2) the risk for developing gallstones in obese persons is three to seven times higher than that in eutrophic persons [3]; and 3) the risk for gallstone formation in patients undergoing rapid weight reduction seems even greater (Table 1). We ask whether these rapid weight-loss programs with very-low-calorie diets are truly useful. Such studies suggest that caloric intake is important to gallstone formation; for example, in the first four studies that did not use UDCA, the incidence of gallstone formation ranged from 0% to 25.4% using diets of 1000 kcal and 500 kcal, respectively. Interestingly, the amount of fat was higher (10 g) in the study using 1000 kcal than in other studies. In the second set of studies, only 520 kcal was used; the incidence of gallstones ranged from 0% to 57.1% in the UDCA groups and from 28.2% to 42.8% in the placebo groups. The fat content in these groups differed, however. Thus, Shiffman and colleagues used 1 to 3 g of fat compared with the 1 g used in other studies. These findings suggest to us that both low-calorie diet and fat composition play important roles in the incidence of gallstone formation in these patients. Ursodeoxycholic acid has been proven safe for both preventing and treating gallstones [4]. It is clear, however, that we need to carefully define the risk for gallstone formation in these patients to improve prophylaxis, treatment cost, and benefit to patients. LETTER
Prevention of Gallstones during Weight Reduction
TO THE EDITOR:
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Nahum Mendez-Sanchez, MD, MSc
Javier Lizardi-Cervera, MD
Misael Uribe, MD
National Institute of Nutrition Salvador Zubiran
Vasco de Quiroga No. 15, Tlalpan 14000
Mexico City, Mexico
Author and Article Information
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References
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TopAuthor & Article InfoReferences |
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1. Shiffman ML, Kaplan GD, Brinkman-Kaplan V, Vickers FF. Prophylaxis against gallstone formation with ursodeoxycholic acid in patients participating in a very-low-calorie diet program. Ann Intern Med. 1995; 122:899-905.
2. Diehl AK. Epidemiology and natural history of gallstone disease. Gastroenterol Clin North Am. 1991; 20:1-19.
3. Stampfer MJ, Maclure KM, Colditz GA, Manson JE, Willett WC. Risk of symtomatic gallstone in women with severe obesity. Am J Clin Nutr. 1992; 55:652-8.
4. Mendez-Sanchez N, Panduro A, Uribe M, et al. Low dose of ursodeoxycholic acid induces apolipoprotein A-1 gene expression and prolongates cholesterol nucleation time in patients with cholesterol gallstones [Abstract]. Hepatology. 1991; 14:148A.
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