Bile Lipid Secretion in Obese and Non-Obese Individuals with and without Gallstones

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Abstract
Biliary lipid secretion rates were measured in nonobese and obese individuals with and without cholesterol gallstones, using a steady-state, amino acid duodenal perfusion method. In addition, biliary lipid secretion rates were measured in 5 obese gallstone patients receiving high-dose chenodeoxycholic acid therapy (16-22 mg/day kg-1). Bile acid secretion rates in the nonobese patients with cholesterol gallstones (563 .+-. SEM 70 .mu.mol/h, n = 6) were significantly lower than in the non-obese controls (1078 .+-. 210 .mu.mol/h, n = 10, P < 0.05), whereas cholesterol secretion rates were similar in the nonobese individuals with and without gallstones (51 .+-. 7 and 42 .+-. 4 .mu.mol/h, respectively). In the obese, both with and without gallstones, the major abnormality was hypersecretion of cholesterol (107 .+-. 7 .mu.mol/h, n = 7, and 81 .+-. 15 .mu.mol/h, n = 7, respectively). Both these values were significantly greater than those in the nonobese controls (P < 0.01-0.02). Biliary cholesterol secretion rates correlated significantly with bile acid secretion rates but, for every mole of bile acid secreted, the obese secreted more cholesterol than the nonobese. Chenodeoxycholic acid treatment lowered biliary cholesterol saturation in obese gallstone patients by reducing biliary cholesterol secretion. These results suggest that there are 2 major types of defect in biliary lipid secretion in gallstone patients: reduced biliary bile acid secretion in non-obese gallstone patients and excessive biliary cholesterol secretion in the obese.