Similarity in gallstone formation from 900 kcal/day diets containing 16 g vs 30 g of daily fat: evidence that fat restriction is not the main culprit of cholelithiasis during rapid weight reduction

Diets containing essentially no fat, 1-2 g fat per day, have resulted in cholesterol gallstones. Greater fat may result in less gallbladder stasis. Do gallstones form with greater fat content? We studied 272 moderately obese subjects who had normal gallbladder ultrasonograms. The 900 kcal/day liquid diets contained either 16 g fat (N = 94) or 30 g fat (N = 178) each day for 13 weeks. A second gallbladder ultrasound was performed. Sixteen of 94 (17.0%) of the 16-g fat group developed stones with a weight loss of 18 (+/- 7) kg and a body mass index (BMI) decrease of 6 (+/- 2) kg/m2. Twenty of 178 (11.2%) of the 30-g fat group developed stones (P = 0.18, no difference in stone formation) with similar weight loss of 20 (+/- 7) kg (P = 0.08) and BMI decrease of 7 (+/- 2) kg/m2 (P = 0.04). Substantial fat for rapid weight-reducing diets resulted in gallstone formation. Since experiments have shown that our higher fat diet, containing 10 g fat per meal, results in maximal gallbladder emptying, cholelithiasis from rapid weight loss may not be solely attributable to gallbladder stasis.     

RNA-mediated signaling in transcription

OBJECTIVE: To study whether major weight loss causes sustained improvement in blood lipids and haemostatic profile in obese subjects, and to compare the influence of two different slimming and maintenance regimens. DESIGN: Two-stranded randomized intervention study. SETTING: University Department. SUBJECTS: Thirty-six out of 43 obese patients recruited from out-patient waiting list completed the study. INTERVENTIONS: Weight loss was achieved by very low energy formula diet (2 MJ/d for 8 weeks, n=18), or low-energy conventional diet (5 MJ/d for 17 weeks, n=18), both combined with anorectic compound. Participants were re-randomized to consume low fat diet ad libitum (n=16), or energy-restricted diet (n=20) for weight maintenance during 24 weeks. MAIN OUTCOME MEASURES: Plasma lipids, fibrinogen, factor VII coagulant activity (FVIIc), and plasminogen activator inhibitor type 1 (PAI-1) antigen. RESULTS: Weight loss averaged 13.6 kg (95% CI: 12.3-14.9 kg). After 24 weeks' weight maintenance, plasma total cholesterol was 9% lower, high density lipoprotein cholesterol 5% higher, triglycerides 30% lower, FVIIc 12% lower, fibrinogen 6% lower, and PAI-1 antigen 34% lower than at baseline (all changes highly significant). There were no significant differences between slimming or maintenance regimens. CONCLUSIONS: Major weight loss is associated with sustained and marked improvements in blood lipids and hemostatic profile, irrespective of the tested slimming and maintenance regimens.     

Effect of dietary manipulation on substrate flux and energy balance in obese women taking the appetite suppressant dexfenfluramine

BACKGROUND: Studies in lean men show poor regulation of energy (EB) and fat balance (FB) during manipulation of dietary ratios of fat to carbohydrate. High-fat (HF), high-energy diets cause hyperphagia and a positive EB and FB. OBJECTIVE: The protocol was designed to measure substrate flux and EB in obese women taking dexfenfluramine (DF) or placebo (PL) during an HF (50% of energy) or low-fat (25% of energy; LF) diet. We hypothesized that alterations in dietary fat would not be regulated and would lead to a positive EB and FB. DESIGN: The study was double-blind, randomized, and placebo-controlled, with 4 treatments (LF/DF, HF/DF, LF/PL, and HF/PL) and a crossover. Five days of continuous, whole-body calorimetry measurements were made in 6 subjects after 8 d of home DF/PL treatment. Macronutrient balance and EB were measured within the chamber as the cumulative difference between ad libitum intake and oxidation. RESULTS: The HF diet increased energy (HF, 10.50 MJ/d; LF, 8.13 MJ/d; P < 0.0001) and fat intakes (HF, 5.34 MJ/d; LF, 2.06 MJ/d; P < 0.0001), leading to a positive EB (delta = 2.37 MJ/d) and FB (delta = 2.31 MJ/d). DF reduced energy (DF, 8.96 MJ/d; PL, 9.66 MJ/d; P < 0.01) and macronutrient intakes, but did not increase energy expenditure (delta = -0.31 MJ/d; P < 0.01), or 24-h fat oxidation (delta = 0.03 MJ/d; P = 0.46). CONCLUSIONS: EB and FB are poorly regulated with HF, energy-dense diets in obese women, which leads to fat deposition and weight gain.     

A randomized comparison of two weight-reducing diets. Calorie counting versus low-fat carbohydrate-rich ad libitum diet

We compared the importance of rate of initial weight loss for long term outcome in obese patients and the efficacy of two different dietary weight maintenance programmes. An initial weight loss of 12.6 kg was achieved either by eight weeks low energy diet (2 MJ/day) (n = 21) or 17 weeks conventional hypocaloric, high protein diet (5 MJ/day) (n = 22) both supported by an anorectic compound (ephedrine 20 mg and caffeine 200 mg thrice daily). Weight loss rate had no effect on long-term weight maintenance. Randomisation to one year weight maintenance of either an ad lib, low fat, high carbohydrate diet or a fixed energy diet (< 8 MJ/day), both supported by reinforcement sessions 2-3 times monthly, resulted in a maintenance of 13.2 of initial 13.5 kg weight loss in the ad lib group versus 9.7 of 13.8 kg in the fixed energy intake group. At follow-up two years after the initial weight loss, 65% of the ad lib group and only 40% of the fixed energy intake group had maintained a weight loss of > 5 kg.     

Weight change in relation to intake of sugar and sweet foods before and after weight reducing gastric surgery

OBJECTIVE: To test the hypothesis that a diet containing many sweet foods is associated with poor weight loss after gastroplasty. SUBJECTS AND METHODS: 375 severely obese subjects followed for 2 y after vertical banded gastroplasty or gastric banding; 34 subjects followed after gastric bypass. RESULTS: Total energy and all macronutrients were reduced 2 y after surgery. Sweet foods were less reduced than other foods, resulting in a relative increase of sugar intake. At 2 y a high relative intake of sugar and fat was associated with a low energy intake and a large weight reduction in the gastroplasty group. In the highest quartile of mono+disaccharide intake (> 142 g) weight loss was 29.9 kg compared to 25.1 kg in lowest quartile (> 72 g). Absolute and relative sugar intake before surgery did not predict weight outcome. At 6 months, i.e. during a period of active weight reduction, energy intake was significantly related to weight loss. CONCLUSION: Gastroplasty patients who continue selecting sweet foods appear to maintain lower energy intakes and lose more weight. However the associations are unlikely to be causal but probably indicative of changes in other aspects of the diet, eg exclusion of regular meals. Since large weight losses are most likely to be associated with low quality diets these results highlight the need for supplementation therapy of gastroplasty patients. Finally the lack of association between presurgical sugar intake and subsequent weight loss brings into question the surgical practice of selectively assigning sweet eaters to gastric bypass.     

Serotoninergic manipulation, meal-induced satiety and eating pattern: effect of fluoxetine in obese female subjects

Twelve nondepressed healthy female obese subjects (BMI > 30 kg/m2) took part in a study which conformed to a double-blind randomized crossover design. Each subject acted as her own control across 2 weeks of treatment with either 60 mg of the 5-HT reuptake inhibitor fluoxetine or matching placebo. On days 7 and 14 of both treatment phases subjects were provided with fixed energy lunch meals high in either CHO or fat. The effect of these meals on satiety during the fluoxetine and placebo phases was assessed by a battery of procedures. Subjects felt less hungry after consuming the high CHO meal than after consuming the high-fat meal. They also felt less hungry when taking fluoxetine than when taking the placebo. Analysis of energy intake from the test meal revealed a main effect of prior lunch meal type (high CHO or high fat) and a main effect of drug treatment. Subjects consumed an average of 574 kcal following the high CHO meal compared to 689 kcal following the high-fat meal. Subjects also consumed an average of 532 kcal when taking fluoxetine compared to 730 kcal when taking the placebo. Fluoxetine did not exert any significant effects on macronutrient selection. Mean daily energy intake, calculated from food diary records, was 1881 kcal when subjects were taking the placebo compared to 1460 kcal when taking fluoxetine (a reduction of 22.4%). Fluoxetine treatment produced a significant weight loss of 1.97 kg over the two weeks of treatment compared to a weight loss of only 0.04 kg on placebo.     

Postprandial changes of electrical activity of the stomach after different meals

AIM: The aim of the study was to investigate the response of the electrical activity of the stomach (electrogastrogram, EGG) to meals, different with respect to consistency, nutrient and caloric composition. METHODS: EGG was recorded in ten healthy volunteers for 30 min before and 45 min after a meal. All subjects received three different meals: A standard 500 kcal solid, a 500 cc isocaloric liquid diet of identical composition (55% carbohydrates, 15% protein, 30% fat) or 500 cc water. Data were analyzed off-line for postprandial changes. RESULTS: Water as well as liquid diet induced a significant postprandial decrease, while solid food induced a slight initial decrease and a subsequent marked increase of the dominant frequency above the fasting level. The response to the solid meal was significantly different from both tap water and liquid diet, but there was no difference between liquid diet and water. All meals significantly increased the signal power with a more sustained effect over time for the liquid diet and water than the solid meal. CONCLUSION: EGG changes seem to be more dependent on the consistency than the caloric and nutrient composition. Because of the dissociation between the timing of EGG changes and the known emptying kinetics, EGG changes seem to reflect other gastric functions rather than being associated with gastric emptying.     

Collagen metabolism in obesity: the effect of weight loss

OBJECTIVE: To investigate the impact of obesity, fat distribution and weight loss on collagen turnover using serum concentrations of the carboxyterminal propeptide of type I procollagen (S-PICP) and the aminoterminal propeptide of type III pro-collagen (S-PIIINP) as markers for collagen turnover. DESIGN: Blood samples were obtained once at baseline, and after 8 and 16 weeks of dietary treatment (5.0 MJ/day diet). SETTING: Outpatient clinic of Hvidovre University Hospital. MAIN OUTCOME MEASURES: S-PICP, S-PIIINP, fat distribution and weight loss. RESULTS: S-PIIINP was associated with body weight (r = 0.37; P = 0.004), height (r = 0.27; P = 0.04), waist circumference (r = 0.35; P = 0.007), as well as with WHR (r = 0.33; P = 0.01) and was inversely correlated to age (r = -0.40; P = 0.002). Compared with randomly selected controls from a large pool of healthy volunteers, the obese patients had elevated S-PIIINP values before as well as during weight loss, whereas S-PICP levels were within the normal range and did not correlate with any anthropometric measures. The average weight loss after 16 weeks dietary treatment was 8.1 kg (s.d. = 0.8). S-PIIINP decreased during the 16 weeks of energy restriction (P < 0.05) and changes in S-PIIINP was correlated to body weight loss (r = 0.32; P < 0.05) and to changes in waist circumference (r = 0.34; P < 0.05) as well as changes in WHR (r = 0.30; P < 0.05). CONCLUSION: S-PIIINP is elevated in obesity and associated with body fat distribution, suggesting an increased turnover of type III collagen related to obesity in general and to abdominal obesity in particular. S-PIIINP levels decreases during weight loss in obese subjects, whereas S-PICP levels seems un-related to obesity and weight loss.     

Daily energy expenditure in free-living conditions in obese and non-obese children: comparison of doubly labelled water (2H2(18)O) method and heart-rate monitoring

OBJECTIVE: To compare the heart-rate monitoring with the doubly labelled water (2H2(18)O) method to estimate total daily energy expenditure in obese and non-obese children. DESIGN: Cross sectional study of obese and normal weight children. SUBJECTS: 13 prepubertal children: six obese (4M, 2F, 9.1 +/- 1.5 years, 47.3 +/- 9.7 kg) and seven non-obese (3M, 4F, 9.3 +/- 0.6 years, 31.8 +/- 3.2 kg). MEASUREMENTS: Total daily energy expenditure was assessed by means of the doubly labelled water method (TEEDLW) and of heart-rate monitoring (TEEHR). RESULTS: TEEHR was significantly (P < 0.05) higher than TEEDLW in obese children (9.47 +/- 0.84 MJ/d vs 8.99 +/- 0.63 MJ/d) whereas it was not different in non-obese children (8.43 +/- 2.02 MJ/d vs 8.42 +/- 2.30 MJ/d, P = NS). The difference of TEE assessed by HR monitoring in the obese group averaged 6.2 +/- 4.7%. At the individual level, the degree of agreement (difference between TEEHR and TEEDLW +/- 2s.d.) was low both in obese (-0.36, 1.32 MJ/d) and in non-obese children (-1.30, 1.34 MJ/d). At the group level, the agreement between the two methods was good in nonobese children (95% c.i. for the bias:-0.59, 0.63 MJ/d) but not in obese children (0.04, 0.92 MJ/d). Duration of sleep and energy expenditure during resting and physical activity were not significantly different in the two groups. Patterns of heart-rate (or derived energy expenditure) during the day-time were similar in obese and non-obese children. CONCLUSION: The HR monitoring technique provides an estimation of TEE close to that assessed by the DLW method in non-obese prepubertal children. In comparison with DLW, the HR monitoring method yields a greater TEE value in obese children.     

Dietary manipulation and energy compensation: does the intermittent use of low-fat items in the diet reduce total energy intake in free-feeding lean men?

OBJECTIVE: The effect of two low-fat treatments on ad libitum energy intake (EI) was investigated in five lean men living within a metabolic facility. DESIGN: Diet was controlled over two consecutive periods of 12 d when either, i) all foods eaten or ii) only a single (lunch) meal, was manipulated to increase the fat content from 20, 40 to 60% of energy, and ad libitum EI measured. RESULTS: All foods: EI increased from 8.6 (2.9 s.d.)-14.8 (3.1 s.d.) MJ/d and energy density (ED) from 4.1 (0.8 s.d.)-7.7 (1.6 s.d.) kJ/g as fat content increased from 20-60% (P < 0.0001). There was no decrease in weight of food eaten across diets (P > 0.05) and hence no energy compensation. Lunch meal: EI (20%:13.1 MJ/d, 40%:13.8 MJ/d, 60%:14.8 MJ/d) and ED (6.03 kJ/g, 5.89 kJ/g, 6.41 kJ/g) increased but not significantly across treatments (P > 0.05). There was partial energy compensation on the low-fat 20% diet (due in part to compensatory increase in fat intake), but no compensation for the high-fat 60% diet. CONCLUSIONS: Changes in total dietary fat and ED result in concomitant changes in EI; low fat diets reducing EI. However, the dietary strategy of intermittent use of low- and high-fat items fail to significantly alter ED, and hence EI, in free-feeding lean men. Whilst there is a trend towards reduction in intake, manipulation of the fat content of a single meal may not be sufficient to induce significant long-term weight loss.     

Association of leptin and hunger-satiety ratings in obese women

OBJECTIVE: To measure leptin, insulin and cholecystokinin (CCK) concentrations in obese women on calorie restriction and to determine their correlation with hunger-satiety ratings. Although it has been proposed to play a role in appetite regulation, the effects of physiological concentrations of these hormones on hunger-satiety in humans have not yet been well established. DESIGN: Prospective metabolic study. A two week 'wash-in period' followed by a three-week observation period, during which each subject underwent six measurements of satiety, blood parameters and body weight. SETTING: Energy Metabolism Research Unit, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA. SUBJECTS: 22 moderately to severely overweight women (mean age: 45 +/- 8 y; body mass index (BMI): 33 +/- 6 kg/m2). INTERVENTION: Energy restriction, in the form of a 3.3 MJ (800 kcal) diet during five weeks. MAIN OUTCOME MEASUREMENTS: Fasting blood levels of leptin, insulin, glucose and CCK, fasting hunger-satiety scores and body weight. RESULTS: The mean (+/- s.d.) fasting serum leptin concentration at the beginning of the observation period was 26.1 +/- 15.9 ng/ml (range: 6.7-59.8 ng/ml). Leptin concentrations correlated positively with body weight (P < 0.0001). Furthermore, reductions in body weight were associated with decreases in fasting leptin levels (P = 0.002). Leptin concentrations correlated with serum levels of insulin (P = 0.0001) and CCK (P = 0.06), but in multivariate analysis including insulin, CCK and glucose, only leptin had a significant relationship with satiety (P = 0.04). This relationship was linear. CONCLUSIONS: These results confirm the association between leptin levels, body weight and serum insulin. We also showed that higher serum leptin levels correlated with greater feelings of fullness, a relationship which was not blunted in the more obese subjects. These findings suggest that leptin is a satiety hormone that reduces appetite, even in obese individuals, and that weight gain must be due to other factors, overriding this feed-back regulation.     

The effect of antiemetics and reduced radiation fields on acute gastrointestinal morbidity of adjuvant radiotherapy in stage I seminoma of the testis: a randomized pilot study

OBJECTIVE: To assess the long term effects of weight loss with and without additional aerobic and weight training exercises on exercise tolerance and cardiorespiratory fitness in obese women. EXPERIMENTAL DESIGN: Randomized prospective study for an approximately one-year community setting. PATIENTS: 31 healthy obese women volunteers (age 42.8 yrs +/- 6 SD) recruited by community advertisement. INTERVENTION: All subjects underwent a weight loss program consisting of low calorie diet and behavior therapy for a minimum of 46 weeks. They were randomly assigned to one of the four groups. Group A: diet alone, Group B: diet plus aerobic exercise program in a supervised group setting, Group C: Diet plus weight training and Group D: diet plus weight training plus aerobic exercise program. MEASURES: Exercise time (Tex) peak sustained workload (Wp), peak oxygen consumption (VO2), oxygen pulse and the rate of change of VO2 on recovery (VO2rec) were measured at the beginning and after 47.5 weeks +/- 1.5 SD, of the program. RESULTS: All subjects lost weight and achieved increased Tex and lowered resting VO2. VO2 peak and VO2 peak kg-1 increase in Groups B and D only. O2 pulse and VO2rec improved in group D. Improvements in exercise time correlated significantly with initial exercise time and weight loss. CONCLUSIONS: Weight loss increase Tex irrespective of participation in an exercise program. However, evidence of improved aerobic fitness occurred only in groups performing aerobic exercise.     

Body composition at farrowing and nutrition during lactation affect the performance of primiparous sows: II. Milk composition, milk yield, and pig growth

We used 35 primiparous sows to investigate the link between body fatness at farrowing and voluntary feed intake (VFI) during lactation. Two groups of sows were fed differently throughout gestation (either 2.3 kg/d of a diet containing 5.8% CP and 14.6 MJ DE/kg as fed or 1.7 kg/d of a diet containing 15.6% CP and 14.5 MJ DE/kg as fed) so that they commenced lactation at a similar body weight (158 to 152 kg) but with different body compositions: either 340 (fat) or 280 (lean) g of body fat/kg BW (P < .001). During lactation, sows were offered either a low-protein diet (7.9% CP and 15.5 MJ DE/kg as fed) or a high-protein diet (19.0% CP and 15.6 MJ DE/kg as fed) on an ad libitum basis. During lactation, VFI was measured daily, and sow body weight and backfat were measured weekly. Blood samples were collected from sows on d 110 of gestation and d 14 and 28 of lactation, and plasma was analyzed for NEFA, glycerol, insulin, glucose, and beta-hydroxybutyrate. Fat sows ate 30% less than their lean counterparts during lactation (P < .001), which corresponded to a 70% higher concentration of NEFA in plasma (P = .01) and a 30% higher concentration of glycerol (P = .15). The VFI during the first 2 wk of lactation was affected only by body fatness and not by the protein content of the lactation diet. The dietary supply of protein influenced VFI during wk 3 and 4 of lactation, possibly by affecting milk production and hence the drive to consume feed. Weight loss, particularly lean tissue loss, was minimized by feeding the high-protein diet during lactation (P < .002).     

Treatment of obesity by behavior therapy and very low calorie diet: A pilot investigation.

Treated 17 obese females (mean age 37.5 yrs) who averaged 87% overweight for 6 mo on a program of diet and behavior modification designed for weight loss maintenance. Ss, who were paid to participate, received a balanced diet of 1,000–2,200 kilocalories/day for Month 1, a low calorie protein liquid (400–500 kilocalories/day) for Month 2, low calorie protein (fish, fowl) for Month 3, and a balanced diet for Months 4–6. Results show that Ss lost an average 20.5 kg during treatment and showed significant reductions in anxiety and depression even while consuming the low calorie diet. At 1-yr follow-up, Ss had regained an average of 2.1 kg. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Energy density of foods affects energy intake in normal-weight women

This study examined the effect of energy density, independent of fat content and palatability, on food and energy intakes. With use of a within-subjects design, normal-weight women (n = 18) were provided with meals for 2 d during each of three test sessions. During lunch, dinner, and an evening snack, subjects were given free access to a main entree varying in energy density (low, medium, or high). The manipulated main entrees were similar in palatability to their counterparts across conditions. Low-energy compulsory (consumption required) side dishes accompanied each meal. Subjects also consumed a standard, compulsory breakfast. Results showed that subjects consumed a similar amount of food (by weight) across the three conditions of energy density. Thus, significantly more energy was consumed in the condition of high energy density (7532 +/- 363 kJ, or 1800 +/- 86 kcal) than in the medium- (6356 +/- 281 kJ, or 1519 +/- 67 kcal) and low- (5756 +/- 178 kJ, or 1376 +/- 43 kcal) energy-density conditions (P < 0.0001). There were no differences in hunger or fullness before meals, after meals, or over the 2 d across conditions. The results from this study indicate that energy density affects energy intake independent of macronutrient content or palatability, suggesting that the overconsumption of high-fat foods may be due to their high energy density rather than to their fat content.     

Effect of an acute reduction in carbohydrate intake on subsequent food intake in healthy men

We investigated the effect of a combined carbohydrate and energy deficit in the regulation of food intake during 1 d. Seven lean, male subjects were studied in a crossover design. After 7 d of consuming a baseline diet (40% of energy as fat, 45% as carbohydrate, and 15% as protein), subjects were deprived of carbohydrate for 24 h; baseline amounts of fat and protein were consumed but only one-third of the baseline amount of carbohydrate. On the following outcome day, subjects were free to select ad libitum from a selection of either high-carbohydrate or low-carbohydrate food. On the baseline diet subjects consumed on average 10.9 +/- 1.7 MJ/d (carbohydrate: 305 +/- 49 g/d; fat: 116 +/- 18 g/d) and there was no difference in baseline intake between the two phases of the crossover study. During the deficit day, intake was reduced to 7.7 +/- 1.2 MJ/d [carbohydrate: 110 +/- 25 g/d (66% reduction); fat: 116 +/- 18 g/d]. On the outcome day, energy intake from high-carbohydrate foods was on average 10.5 MJ/d (carbohydrate: 430 +/- 112 g/d; fat: 48 +/- 20 g/d) compared with 16.6 MJ/d from high-fat foods (carbohydrate: 312 +/- 84 g/d; fat: 258 +/- 78 g/d). We conclude that the restoration of an energy deficit is not the main factor determining acute food intake. Rather, the data support the hypothesis that, under the conditions of our experiment, the intake of carbohydrate required to maintain carbohydrate balance was a more important factor in the regulation of acute food intake than was the restoration of energy deficit is not.     

Influence of degree of obesity on loss of fat-free mass during very-low-energy diets

This study examined the influence of initial degree of obesity on loss of fat-free mass (FFM). One hundred twelve obese females participated in a series of very-low-energy diet (VLED) clinical trials. Obesity groups were determined by three common methods: percent body fat, body mass index, and weight. Within each group, subjects were classified into low-, intermediate-, and high-obesity groups. As expected, the high-obesity group lost comparable amounts or more weight and more fat weight than the low- and intermediate-obesity classifications for each group. The high-obesity group lost approximately 2% more FFM (P < 0.05) compared with the low and intermediate group when subjects were grouped by body mass index and weight and showed no differences between classifications when subjects were grouped by percent body fat. No differences were found between classifications for ratios of FFM to weight loss regardless of how subjects were grouped. Thus, the degree of obesity does not seem to affect loss of FFM.     

Gallbladder emptying and gallstone formation: a prospective study on gallstone recurrence

BACKGROUND & AIMS: Gallbladder emptying is reduced in many patients with cholesterol gallstones. To clarify the role of impaired gallbladder motility in recurrent gallstone disease, the effect of gallbladder emptying on the formation of recurrent stones was studied prospectively. METHODS: In 54 consecutive patients with single radiolucent gallbladder stones, postprandial gallbladder emptying was assessed sonographically before lithotripsy and 1.8 +/- 0.1 years (mean +/- SE) after gallstone disappearance. Patients were followed up for gallstone recurrence for 0.6-4.1 years (median, 2.6 years). RESULTS: After gallstone disappearance, gallbladder fasting volume (33.7 +/- 3.4 vs. 27.8 +/- 3.0 mL; P = 0.007) and residual volume (12.6 +/- 1.9 vs. 9.7 +/- 1.3 mL; P = 0.010) decreased, whereas the ejection fraction remained unchanged. However, gallbladder volume did not differ whether initial or recurrent stones were present. Gallbladder emptying was more impaired in patients with than patients without later recurrence (47% +/- 5% vs. 63% +/- 2%; P = 0.001). Cox analysis showed that gallbladder emptying was an independent determinant of the risk of gallstone recurrence (P = 0.002). Within 3 years, recurrent stones formed in 53% (actuarial analysis) of patients with an ejection fraction of < 60% but in only 13% of patients with an ejection fraction of > or = 60%. CONCLUSIONS: Gallbladder emptying is an important factor in the formation of recurrent gallstones.     

Ultrasonic evaluation of gallbladder emptying with ceruletide: comparison to oral cholecystography with fatty meal

Assessment of gallbladder function is required prior to nonsurgical treatment of gallstones. In order to develop a practical and reproducible method of evaluation, gallbladder emptying was studied by ultrasound (US) in 55 gallstone patients after intramuscular administration of ceruletide (0.3 micrograms/kg). In 27 of these subjects, the US procedure was compared to oral cholecystography (OCG) with fatty meal. Maximal percent gallbladder contraction was reached 30 min after ceruletide in all patients. Maximal percent contractions were 47.5 +/- 27.7 during US with ceruletide and 33.9 +/- 16.3 during OCG with fatty meal (p = 0.03). A significant linear relationship was found between the results obtained with the two different procedures (r = 0.57; p = 0.002). Serial US determinations of gallbladder emptying were performed in 16 patients. Individual variation was below 20% in 11 subjects, and in five subjects it ranged between 20 and 40%. Minor, self-limiting side effects were observed in 13 patients. US determination of gallbladder emptying after ceruletide appears to be a practical and reliable method to assess gallbladder function.