Published: Dec 17, 2013 | Updated: Dec 17, 2013
By Cole Petrochko, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
- In a meta-analysis of randomized controlled trials of participants undergoing weight loss, ursodeoxycholic acid use was associated with a reduced risk of gallstones.
- Diets high in fat content also were associated with fewer gallstones, compared with those with low fat content.
Patients undergoing rapid weight loss who either received ursodeoxycholic acid (Ursodiol) or ate a high-fat diet had a reduced risk of gallstones, researchers found.
Compared with control treatments, risk for gallstones was significantly reduced among patients who received daily supplements of ursodeoxycholic acid (RR 0.33, 95% CI 0.18-0.60), according to Frank Lammert, MD, of Saarland University Hospital in Homburg, Germany, and colleagues.
There was also a significant reduction in gallstone formation in patients who consumed a high-fat diet versus a low-fat diet (RR 0.09, 95% CI 0.01-0.61), they wrote online in the journal Clinical Gastroenterology and Hepatology.
A study printed in the journal Hepatologyin July 2013 showed a causal relationship between high body mass index (BMI) and gallstones, particularly among women.
Similar findings were reported in the Journal of Pediatric Gastroenterology and Nutrition in August 2012 among overweight or obese children and teens; those who were moderately obese had more than four-fold risks for gallbladder disease compared with normal-weight pediatric patients.
The authors reviewed randomized controlled trials of nonsurgical gallbladder stone preventive interventions in adult patients who underwent rapid weight loss through bariatric surgery or with diet alone, an analysis that included 13 studies and 1,837 obese participants combined.
Outcomes included in the analysis were formation of ultrasonically-verified gallstones, mortality, and adverse events. Secondary outcomes included quality of life, cholecystectomy, bile lithogenicity, and weight loss.
Control interventions included placebo treatment, no intervention, or pharmacological and nonpharmacological interventions.
Low- versus high-fat diets were examined in two studies, which included groups receiving 3 g versus 12.2 g of fat, and 2 g versus 30 g of fat, each in daily quantities. Participants in the remaining 11 studies received 300 to 1,200 mg daily of ursodeoxycholic acid at a median 750 mg per day.
Participants were treated from 6 weeks to 18 months and were followed up with for 6 weeks to 24 months.
In the studies of ursodeoxycholic acid, 5% of those in a treatment arm developed gallstones versus 23% of those in the control arm. No deaths occurred in either arms of the studies. Treatment with ursodeoxycholic acid was associated with a reduced risk of cholecystectomy (RR 0.20, 95% CI 0.07-0.53).
Weight loss was equal among groups in all of the ursodeoxycholic acid trials. Among those who received bariatric surgery as their weight-loss intervention, type of surgery did not affect ursodeoxycholic acid-related outcomes, nor did dosage of ursodeoxycholic acid. Quality of life was not assessed in these studies.
In studies comparing high- versus low-fat diets, no patients in the high-fat groups developed gallstones, compared with 45% of control patients. There was no significant difference in weight lost. Quality of life was not assessed. Bile lithogenicity did not differ significantly between the two studies.
There were no adverse events reported with the high- versus low-fat diet studies.
Few serious events were reported related to ursodeoxycholic acid consumption; gastrointestinal-related complaints were the most common adverse events.
The authors noted that the small number of identified trials and low sample sizes in each trial limited their study. In addition, high risk of attrition bias may have also limited outcomes. The research was limited by an inability to perform a meta-analysis of other interventions that reduce cholesterol precipitation in bile.
The authors received support from the Falk Foundation and Merck.
Primary source: Clinical Gastroenterology and Hepatology
Source reference: Lammert F, et al "Ursodeoxycholic acid and high-fat diets prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials" Clin Gastroenterol Hepatol 2013; DOI: 10.1016/j.cgh.2013.11.031.