Epidemiologic studies among specific populations have helped to define the risk for gallstone disease among persons losing weight. During follow-up of the Nurses Health Study cohort, the incidence of clinically recognized gallstones was determined after collection of self-reported heights and weights obtained 2 years apart.
Compared with women whose weight changed less than 4 kg, women who lost 4 to 10 kg had a 44% increase in the risk for gallstone disease with the weight loss, and women who lost more than 10 kg had a 94% increase in the risk for gallstone disease when controlling for BMI and other risk factors for gallstones.
A study in Maastricht, the Netherlands, evaluated the relative contributions of BMI and a history of dieting (yes or no) among 151 men and women who were hospitalized for acutely symptomatic gallstones compared with community controls [29].
Using univariate analysis, a history of dieting doubled the risk for gallstones, but this association largely disappeared with control for the confounding effects of BMI. In an ultrasonographic study of a representative sample from Copenhagen County, Denmark, men with a history of more than one "slimming treatment" (weight loss of more than 5 kg) had a statistically significant doubling of gallstone disease prevalence (11.0% compared with 5.2%).
Women had a statistically nonsignificant 79% increase in gallstone disease prevalence with more than one slimming treatment (17.9% compared with 10.2%). Among men, but not women, the association was statistically significant after adjustment for all other risk factors, including highest body mass index ever (a nonsignificant risk factor among men).
In the first U.S. National Health and Nutrition Examination Survey, a history of dieting among women (but unknown degree of weight change) was associated with an increase (67%; P = 0.001) in incidence of hospitalization with gallstones during the following 10 years [30].
All of these studies excluded patients with previously undetected gallstones before treatment (about 4% to 8% [32, 33, 35, 36]) and then evaluated all available patients for the development of gallstones after weight loss.
If persons on weight reducing diets eat fewer meals and therefore increase overnight fasting periods, they may be at higher risk for development of gallstones. A U.S. population-based study found a doubling of incidence of hospitalization for gallstones among women who fasted overnight for more than 14 hours compared with women who fasted for 8 or fewer hours [30]. Fasting increases gallbladder bile lithogenicity and gallbladder volume [50, 52-55].
No data were presented in these or other studies on the risks for repeated dieting for the development of gallstones. No study has compared the risk for gallstones among weight loss diets differing in caloric content or nutrient composition. It is not known if weight loss due to increased physical activity has any effect on gallstone formation.
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