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Cited by 58Gallbladder and Bile Duct DisordersBiliary and Gastrointestinal FistulasBariatric Surgery and Outcomes

The DOI matches its Crossref record; 95 of the 95 references it cites were found in a registry or an index; 19 of the 88 sources its claims cite were checked for support.

Excess Body Weight and Gallstone Disease

Open access
Stokes, Caroline Sarah, Lammert, Frank·2021·Visceral Medicine
DOI 10.1159/000516418PMC PMC8406364
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Approximately one fifth of adults are diagnosed with gallstones worldwide. Of these, around 25% develop gallstone disease (indicated by the presence of symptoms) and undergo cholecystectomy. Summary: The risk of gallstones is influenced by a combination of genetic and lifestyle factors, such as excess body weight. In fact, body mass has been demonstrated to be a major risk factor for symptomatic gallstones. Rapid weight loss can also initiate a prolithogenic state and further increase the likelihood of either gallstone formation or existing gallstones becoming symptomatic; however, sensible weight loss strategies can mitigate this risk. This review discusses the role of excess body weight and the risk of gallstone disease, as well as the options available for the prevention of symptomatic gallstones. Key Messages: Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones. Should rapid weight loss be required for health reasons or be expected, e.g., after bariatric surgery, prophylactic ursodeoxycholic acid during the period of weight reduction has been demonstrated to reduce the incidence of gallstones formation or symptomatic gallstone occurrence. The recent German guidelines on gallstones recommend simultaneous cholecystectomy during bariatric surgery but only for those with preexisting symptomatic stones.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Excess body weight is a major modifiable risk factor for cholesterol gallstones and symptomatic gallstone disease, while rapid weight loss and weight cycling can further increase risk. Sensible weight loss, healthy diet and activity, and prophylactic ursodeoxycholic acid during high-risk weight reduction can reduce gallstone formation and symptoms.

Key findings

  • Gallstones affect up to 20% of adults worldwide; about 25% develop symptoms/complications, and approximately 90% of stones are cholesterol stones.
  • Increased BMI is causally linked to symptomatic gallstones: in a Mendelian randomization study of 77,679 individuals, symptomatic gallstones occurred in 5.2% (4,106 individuals) over up to 34 years, with findings more distinct in women.
  • Rapid weight loss (>1.5 kg/week) and excessive weight reduction (>25% body weight) increase gallstone risk; after gastric bypass or biliopancreatic diversion, biliary sludge/gallstones occurred in 30% during the 6-month period, and a comparable 30% incidence was reported after sleeve gastrectomy at 6–12 months. Weight cycling increased cholecystectomy risk by 31% for moderate (4.5–8.5 kg) and 68% for severe (≥9 kg) fluctuations.
  • Prophylactic ursodeoxycholic acid (UDCA) reduced gallstone formation by as much as 58% in randomized controlled trials; a minimum dose of 500 mg/day is recommended. In one randomized trial of 190 patients after one anastomosis gastric bypass, gallstones at 12 months occurred in 4.2% with UDCA 600 mg/day versus 25.2% in controls (p < 0.05), with UDCA the only significant predictor (HR = 0.17; 95% CI 0.06–0.48; p < 0.001). Recent German and European guidelines recommend simultaneous cholecystectomy during bariatric surgery only for patients with preexisting symptomatic gallstones.

Methods

  • Narrative review focusing on modifiable risk and prevention of gallstones related to obesity in adults.
  • Synthesizes evidence on body weight, fat distribution, pathophysiological mechanisms, rapid weight loss and weight cycling, diet and physical activity, prophylactic UDCA, cholecystectomy, and guideline recommendations.
  • Draws on epidemiological studies, randomized controlled trials, meta-analyses, and guidelines, including a Mendelian randomization study, the Swedish Obese Subjects study, and German/European gallstone guidelines.

Limitations

  • The paper does not state a limitations section; it reports no funding and no conflicts of interest.
  • Evident from the text: this is a narrative review without a described systematic search strategy or formal risk-of-bias assessment.
  • Evident from the text: the evidence base includes observational, retrospective, and heterogeneous intervention studies, and some findings come from specific populations or settings, which may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1159/000516418

Cites

95 of 95 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

19 of 88 cited sources checked · 2 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Increased BMI is causally linked to the risk of symptomatic gallstones.

    “an increased BMI has been demonstrated to be causally linked to the risk of symptomatic stones, as illustrated in a mendelian randomization study in 77,679 individuals [8].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] source

      The Discussion reports a Mendelian randomization study of 77,679 individuals and finds genetically elevated BMI associated with increased risk of symptomatic gallstone disease. It concludes that elevated BMI is likely a causal risk factor, but the citing sentence’s “has been demonstrated” is more definitive than the paper’s qualified conclusion. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    Weight cycling is an independent risk factor for gallstones.

    “Weight cycling (i.e., weight that is lost and regained) is an independent risk factor for gallstones [34][35][36].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [34] source
    • cites [35] source
    • cites [36] source

      The Introduction (page not provided) says obesity and rapid weight loss increase the risk of gallstone formation. It does not address weight regain or establish that weight cycling is an independent risk factor; searches for weight cycling and weight regain found no such passage. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Higher concentrations of high-sensitivity C-reactive protein (CRP) are an independent risk factor for new-onset cholesterol gallstones.

    “a Chinese study observed higher concentrations of (high-sensitivity) C reactive protein (CRP) to be an independent risk factor for new-onset cholesterol gallstones [22].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [22] source

      The Introduction describes CRP as an inflammatory marker associated with obesity, and §3.1 identifies high-sensitivity CRP as a marker used to screen for inflammation. Searches for gallstones, new-onset cholesterol gallstones, and a Chinese study found no passage linking CRP to gallstone risk. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    The prevalence of gallstones in individuals younger than 50 years with obesity and metabolic syndrome was identical to the prevalence in elderly people who were metabolically healthy and not obese.

    “the prevalence of gallstones in individuals younger than 50 years with obesity and metabolic syndrome was identical to the prevalence of gallstones in elderly people who were metabolically healthy and not obese.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] source

      The Conclusions describe the two groups’ gallstone prevalence as equal, supporting the comparison. The Results (Baseline characteristics) give rates of 7.2% and 6.8%, however, so the prevalences were similar rather than numerically identical. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    A high-sensitivity CRP concentration >3 mg/L is associated with a 12% increased risk of stones.

    “a high-sensitivity CRP concentration >3 mg/L was associated with a 12% increased risk of stones.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [22] source

      The Introduction identifies CRP as an inflammatory marker associated with obesity, but does not discuss stone risk. Searches for high-sensitivity CRP, the >3 mg/L threshold, stones, and a 12% increase found no passage addressing the claimed association; no page number is available in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
  • It may state two separate claims as one. 27
  • Probably not a substantial claim. 4
  • The quote only partly states this claim. 1

  • It may state two separate claims as one.

    Premisecitation

    Unsaturated fatty acids reduce gallstone risk, while saturated and trans fats increase it.

    “Dietary lipids are mediators of gallstone risk, with unsaturated fatty acids displaying risk reduction properties and saturated and trans fats increasing the risk [70][71][72].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [70] source

      The Patients and methods passage reports that fish oil improved gall-bladder motility in patients with hypertriglyceridaemia, a proposed contributor to gallstone risk. The paper does not establish that unsaturated fatty acids reduce gallstone incidence, and the passages do not address increased risk from saturated or trans fats. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [71] source

      The Discussion (page unavailable) explicitly reports no association between gallstones and saturated, monounsaturated, or polyunsaturated fat intake, contrary to the claimed risk increase and reduction. The Results likewise report no association for these fats; the paper does not address trans fats. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [72] source

  • It may state two separate claims as one.

    Premisecitation

    In a mendelian randomization study of 77,679 individuals, symptomatic gallstones occurred in 5.2% (4,106 individuals) over up to 34 years of follow-up, with findings more distinct in women.

    “This report showed symptomatic gallstones in 5.2% (4,106 individuals) of cases in up to 34 years of follow-up, with the findings being more distinct in women.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] source

      Patients and Methods gives 67,314 plus 10,365 participants (77,679 total), and Table 1 reports 4,106 with symptomatic gallstone disease. The Results report follow-up ranging up to 34.4 years and a stronger BMI association in women. However, Table 1 and the Discussion give the proportion as 5.3%, not 5.2%. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    Increased body weight is associated with reduced gallbladder motility, which contributes to stone production.

    “Increased body weight is additionally associated with reduced gallbladder motility, another factor that contributes to stone production [21].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [21] source

      The Discussion (page not provided) says obesity is closely related to stone formation and that increased gallbladder wall thickness may reduce motility. It links the possible motility reduction to gallbladder inflammation, however, not to increased body weight; it also presents that mechanism as uncertain. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Cholecystectomy is the gold standard treatment for symptomatic gallstones.

    “for which (laparoscopic) cholecystectomy (gallbladder removal) is the gold standard treatment [1].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] source

      The Gallstones section (page unavailable) says most hospitalizations involving gallstones were for cholecystectomy and that many procedures were laparoscopic. It does not identify cholecystectomy as the gold-standard treatment or specifically address symptomatic gallstones. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    Both obesity and abdominal obesity increase the risk of stone formation and of requiring cholecystectomy because of higher likelihood of symptomatic stones.

    “Both obesity and abdominal obesity increase the risk not only of stone formation but also of requiring surgical treatment (cholecystectomy) because of the higher likelihood of presenting with symptomatic stones [10,12,13].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [10] source

      The Results and Conclusion (pages unavailable) associate abdominal adiposity with increased cholecystectomy risk in women, independently of BMI. The Methods say symptomatic gallstones are the main indication for surgery, but the Discussion says the study did not screen for gallstones. It therefore does not establish that obesity increases stone formation or that a greater likelihood of stones becoming symptomatic explains the surgical risk. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [12] source
    • cites [13] source

  • It may state two separate claims as one.

    Premisecitation

    A minimum dose of 500 mg/day of UDCA is recommended, and this dose is more effective than 300 mg/day in reducing the risk of gallstones forming during a 6-week period and after 3-4 months.

    “A minimum dose of 500 mg/ day is recommended, as shown in clinical trials and a meta-analysis of such trials, with this dose being more effective than 300 mg/day in reducing the risk of gallstones forming during a 6-week period but also after 3-4 months [53].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [53] source

      The Discussion addresses dietary energy density and weight gain over six years, not gallstone prevention. Searches of our untruncated copy for UDCA, the 500-versus-300 mg/day comparison, and gallstone formation at six weeks or three to four months found no relevant passage. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    The increased risks of gallstones with bariatric surgery and very low-calorie diets are approximately 30% and 25%, respectively.

    “The increased risks of gallstones have been illustrated with 2 popular weight reduction methods, i.e., bariatric surgery and very low-calorie diets [26][27][28]51], with approximate risks of 30 and 25%, respectively [26,28].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] source
    • cites [28] source

  • It may state two separate claims as one.

    Premisecitation

    Concomitant cholecystectomy results in longer operation times, longer hospital stays, and higher complication rates.

    “Studies have reported concomitant cholecystectomy to result in longer operation times, longer hospital stays, and higher complication rates [39,40].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [39] source
    • cites [40] source

  • It may state two separate claims as one.

    Premisecitation

    Abdominal adiposity is associated with insulin resistance, which is reported as a key factor in gallstone formation due to its stimulating effects on hepatic cholesterol secretion.

    “Abdominal adiposity is associated with insulin resistance which, given its stimulating effects on hepatic cholesterol secretion, is reported as a key factor in gallstone formation [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

  • It may state two separate claims as one.

    Premisecitation

    In the Swedish Obese Subjects study, during 26 years of follow-up, the control group had modest weight changes (3% fluctuations), while the surgical group had weight loss averaging 25% at 2 years and 16% at both 10 and 15 years.

    “During 26 years of follow-up, modest weight changes were observed in the control group (3% fluctuations), in contrast to the surgical group where weight loss averaged 25% at 2 years and 16% at both 10 and 15 years.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] source

  • It may state two separate claims as one.

    Premisecitation

    In general, weight loss reduces the risk of gallstones, except in extremely rapid weight loss (>1.5 kg/week) and excessive weight reduction (>25% body weight).

    “In general, weight loss reduces the risk of gallstones, with the exception of 2 specific settings: weight loss that is extremely rapid (i.e., >1.5 kg/week) and excessive weight reduction (i.e., >25% body weight) [25][26][27].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [25] source
    • cites [26] source
    • cites [27] source

  • It may state two separate claims as one.

    Premisecitation

    Cholesterol supersaturation of gallbladder bile has been documented in obese patients but not in nonobese controls.

    “cholesterol supersaturation of gallbladder bile has been documented in obese patients but not in nonobese controls [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

  • It may state two separate claims as one.

    Premisecitation

    In the Swedish Obese Subjects study, symptomatic gallstone incidence differed significantly (p < 0.001), with the surgery group reporting 307 first-time events versus 252 in controls.

    “Symptomatic gallstone incidence differed significantly (p < 0.001), with the surgery group reporting 307 first-time events versus 252 in the controls.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] source

  • It may state two separate claims as one.

    Premisecitation

    Moderate (4.5-8.5 kg) and severe (≥9 kg) fluctuations in a single weight cycle increase the risk of cholecystectomy by 31% and 68%, respectively.

    “Syngal et al. [35] observed both moderate (4.5-8.5 kg) and severe (≥9 kg) fluctuations in a single weight cycle to increase the risk of cholecystectomy by 31 and 68%, respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] source

  • It may state two separate claims as one. The quote only partly states this claim.

    Premisecitation

    In patients with asymptomatic gallstones treated with UDCA for 6 months after bariatric surgery, only 1 of 61 required cholecystectomy and 1 reported symptoms, while 59 remained asymptomatic.

    “Della Penna et al. [49] followed up 61 patients with asymptomatic gallstones treated with ursodeoxycholic acid (UDCA) for 6 months after bariatric surgery (either laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy).”
    • Also stated in: § Prevention and Treatment of Gallstones in Obesity · plain
      “Cholecystectomy was required in 1 patient only who had undergone sleeve gastrectomy.”
    • Also stated in: § Prevention and Treatment of Gallstones in Obesity · plain
      “The remaining 59 patients remained asymptomatic with UDCA prophylaxis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] source

  • It may state two separate claims as one.

    Premisecitation

    In the Swedish Obese Subjects study, complicated gallstones and cholecystectomies were more frequent in the surgery group: 172 vs 144 first-time events (p < 0.006) and 230 vs 170 cases (p < 0.001).

    “A similar trend was observed for complicated gallstones and the rate of cholecystectomies, with 172 versus 144 first-time events (p < 0.006) and 230 versus 170 cases (p < 0.001), respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] source

  • It may state two separate claims as one.

    Premisecitation

    Increased body fat is lithogenic, and higher body weight is associated with greater risk of cholesterol stones in the gallbladder.

    “Thus, increased body fat is lithogenic [19], and the higher the body weight, the greater the risk of cholesterol stones in the gallbladder [12].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] source
    • cites [12] source

  • It may state two separate claims as one.

    Premisecitation

    Alterations of the ratio of cholesterol to bile salts within the gallbladder occur in weight fluctuations and rapid weight loss, reflecting increased hepatic cholesterol secretion and synthesis and reduced secretion of bile salts.

    “Alterations of the ratio of choles-DOI: 10.1159/000516418 terol to bile salts within the gallbladder were observed in the setting of weight fluctuations and in rapid weight loss [37], reflecting increased hepatic cholesterol secretion and synthesis as well as a reduced secretion of bile salts [18].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] source
    • cites [18] source

  • It may state two separate claims as one.

    Premisecitation

    The risk of secondary cholecystectomy after laparoscopic Roux-en-Y reconstruction is 6.8%, with 5.3% of these cases presenting with symptoms.

    “The risk of secondary cholecystectomy was demonstrated to be 6.8% (with 5.3% of these cases presenting with symptoms) after laparoscopic Roux-en-Y reconstruction, as reported in a meta-analysis of 13 studies, 12 of which were retrospective [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Premisecitation

    The Swedish Obese Subjects study reported an overall low cumulative incidence for cholecystectomy after bariatric surgery.

    “The Swedish Obese Subjects study [50] also supports the recent guidelines, reporting an overall low cumulative incidence for cholecystectomy after bariatric surgery.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] source

  • It may state two separate claims as one.

    Premisecitation

    Impairment in gallbladder motility occurs in weight fluctuations and rapid weight loss, triggering the formation of biliary sludge.

    “An impairment in gallbladder motility also occurs, which triggers the formation of biliary sludge [37,38].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] source
    • cites [38] source

  • It may state two separate claims as one.

    Premisecitation

    Prophylactic ursodeoxycholic acid during the weight reduction phase reduces the formation of gallstones regardless of the method of weight loss (low-calorie diets or bariatric surgery), with reductions as high as 58% reported in randomized controlled trials.

    “During the weight reduction phase, prophylactic ursodeoxycholic acid has shown great promise in reducing the formation of gallstones regardless of the method of weight loss, i.e., low-calorie diets or bariatric surgery, with reductions as high as 58% reported in randomized controlled trials [25,29,31,53,[82][83][84][85].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25,29,31,53,[82][83][84][85]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Premisenone given

    Recent guidelines do not recommend simultaneous cholecystectomy during bariatric surgery unless the patient has a preexisting diagnosis of symptomatic gallstones.

    “recent guidelines do not recommend simultaneous cholecystectomy during surgery unless the patient has a preexisting diagnosis of symptomatic gallstones”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    In obese women without gallstones randomized to omega-3 fatty acids, UDCA, or placebo for 6 weeks, no reduction of biliary cholesterol saturation was observed, and none developed gallstones during the intervention.

    “Another study in obese women without gallstones who were randomized to receiving omega-3 fatty acids or UDCA or placebo for 6 weeks did not observe a reduction of biliary cholesterol saturation, despite the fact that none of the participants developed gallstones during this intervention period [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] source

  • It may state two separate claims as one.

    Interpretationnone given

    Rapid weight loss or weight cycling might trigger a lithogenic cascade and further increase the probability of either gallstones forming or of stones becoming symptomatic.

    “rapid weight loss or weight cycling might trigger a lithogenic cascade and further increase the probability of either gallstones forming or of stones becoming symptomatic”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    In a randomized study, moderate training improved gallbladder motility, but results were similar in the control group.

    “improvements in gallbladder motility were observed in a randomized study, where the intervention included moderate training, but the results were similar in the control group [80].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] source

  • It may state two separate claims as one.

    Interpretationreasoning

    Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones.

    “Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    Studies suggest the first 6 months after surgery are the most critical because they are associated with the greatest reduction in body weight, with UDCA showing mild benefits after the first 6 months that do not justify prolonged prophylaxis.

    “Studies suggest the first 6 months after surgery to be the most critical because they are associated with the greatest reduction in body weight, with UDCA showing mild benefits after the first 6 months that do not justify prolonged prophylaxis [88].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Interpretationnone given

    Healthy nutrition emphasizing plant foods and unsaturated fats combined with regular physical activity can promote successful weight loss and weight maintenance.

    “Healthy nutrition with an emphasis on plant foods and unsaturated fats combined with regular physical activity can promote successful weight loss and weight maintenance.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premiseown data

    The majority of gallstones in that study were asymptomatic, with only 28.6% of participants displaying symptoms.

    “The majority were asymptomatic, with only 28.6% of participants displaying symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    In a randomized study of 190 patients undergoing 1 anastomosis gastric bypass, the incidence of gallstones after 3 months was 0 vs 4 (4.2%) in the UDCA and control groups, and 3 (3.1%) vs 21 (22.1%) at 6 months.

    “The incidence of gallstones after 3 months was 0 versus 4 (4.2%) in the UDCA and control groups, respectively, and 3 (3.1%)versus 21 (22.1%) at 6 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

31 of 31

  • The paper relies on this without support.

    Each extra kilogram of body fat yields the production of approximately 20 mg of additional cholesterol.

    “It has been estimated that each extra kilogram of body fat yields the production of approximately 20 mg of additional cholesterol.”

  • The paper relies on this without support.

    Excess cholesterol is secreted by hepatocytes as a direct result of increased body weight.

    “This excess cholesterol is secreted by hepatocytes as a direct result of increased body weight.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Three cases among 95 are reported as 3.1%

    Minor

    Three of 95 patients is 3.158%, which rounds to 3.2% at the reported precision.

    Reported 3.1 · recomputed 3.157895

  • Symptomatic gallstone percentage does not match the reported count

    Minor

    Of 77,679 individuals, 4,106 is 5.286%, which rounds to 5.3%, not 5.2%.

    Reported 5.2 · recomputed 5.285856

2 of 2

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Metadata

Authors
Stokes, C. S., & Lammert, F.
Affiliations
  • Humboldt-Universität zu Berlin (DE)
  • Medizinische Hochschule Hannover (DE)
ORCID
Venue
Visceral Medicine
Publisher
S. Karger AG
Published
2021
Volume
37
Issue
4
Pages
254-260
ISSN
  • 2297-4725 (ISSN-L)
  • 2297-475X
DOI
10.1159/000516418
PMC
PMC8406364
OpenAlex
W3166882002
Semantic Scholar
a8dad5021dd8b7c0c125a4d2a91bcfe2e376f14f
Cited by
58
References
89
Citations by year
2026: 14 · 2025: 18 · 2024: 14 · 2023: 7 · 2022: 4 · 2021: 1
FWCI
1.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Visceral Medicine (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gallbladder and Bile Duct Disorders
  • Health Sciences › Medicine › Gastroenterology › Biliary and Gastrointestinal Fistulas
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords
gallstone disease, overweight, obesity, symptomatic gallstones, cholecystectomy, rapid weight loss, bariatric surgery, ursodeoxycholic acid, weight loss diet, physical activity, gallstone prevention

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