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Long-Term Weight Patterns and Risk for Cholecystectomy in Women

Sapna Syngal, MD, MPH; Eugenie H. Coakley, MA, MPH; Walter C. Willett, MD, DrPH; Tim Byers, MD, MPH; David F. Williamson, PhD, MS; and Graham A. Colditz, MD, DrPH
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From Channing Laboratory, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Centers for Disease Control and Prevention, Atlanta, Georgia; and University of Colorado Medical School, Denver, Colorado.

Ann Intern Med. 1999;130(6):471-477. doi:10.7326/0003-4819-130-6-199903160-00003
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Background: Obesity and rapid weight loss in obese persons are known risk factors for gallstones. However, the effect of intentional, long-term, moderate weight changes on the risk for gallstones is unclear.

Objective: To study long-term weight patterns in a cohort of women and to examine the relation between weight pattern and risk for cholecystectomy.

Design: Prospective cohort study.

Setting: 11 U.S. states.

Participants: 47 153 female registered nurses who did not undergo cholecystectomy before 1988.

Measurements: Cholecystectomy between 1988 and 1994 (ascertained by patient self-report).

Results: During the exposure period (1972 to 1988), there was evidence of substantial variation in weight due to intentional weight loss during adulthood. Among cohort patients, 54.9% reported weight cycling with at least one episode of intentional weight loss associated with regain. Of the total cohort, 20.1% were light cyclers (5 to 9 lb of weight loss and gain), 18.8% were moderate cyclers (10 to 19 lb of weight loss and gain), and 16.0% were severe cyclers (≥ 20 lb of weight loss and gain). Net weight gain without cycling occurred in 29.3% of women; net weight loss without cycling was the least common pattern (4.6%). Only 11.1% of the cohort maintained weight within 5 lb over the 16-year period. In the study, 1751 women had undergone cholecystectomy between 1988 and 1994. Compared with weight maintainers, the relative risk for cholecystectomy (adjusted for body mass index, age, alcohol intake, fat intake, and smoking) was 1.20 (95% CI, 0.96 to 1.50) among light cyclers, 1.31 among moderate cyclers (CI, 1.05 to 1.64), and 1.68 among severe cyclers (CI, 1.34 to 2.10).

Conclusion: Weight cycling was highly prevalent in this large cohort of middle-aged women. The risk for cholecystectomy associated with weight cycling was substantial, independent of attained relative body weight.


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Figure 1.
Relation of body mass index at 18 years of age (striped bars) and in 1988 (white bars) with risk for cholecystectomy in 1988 to 1994 in the Nurses' Health Study, adjusting for age, energy-adjusted fat intake, smoking, and alcohol intake.2

The striped bar in the category labeled 30 to 34.9 represents the risk for gallstones in women with body mass index of 30 kg/m or more at 18 years of age. Error bars represent 95% CIs.

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Figure 2.
Prevalence of weight patterns in the study cohort from 1972 to 1988, stratified by age in 1988.

Weight losers were women with weight loss of more than 5 lb; weight maintainers were those whose weight did not fluctuate by more than 5 lb and who did not have episodes of intentional weight loss; weight gainers were those who gained more than 5 lb; and weight cyclers were those with weight gain or maintenance accompanied by intentional weight loss. Light cyclers were women with a maximum weight loss per episode of 5 to 9 lb; moderate cyclers were those with a maximum loss per episode of 10 to 19 lb; and severe cyclers were those with a maximum loss per episode of 20 lb or more. White bars represent women 40 to 49 years of age; striped bars represent women 50 to 59 years of age; and black bars represent women 60 to 69 years of age.

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