Obesity, dyslipidemia and cholesterol gallstone disease during one year of Antarctic residence

Abstract

Age, gender, ethnicity, geographic location, diet, obesity, diabetes mellitus and dyslipidemia are known risk factors for development of gallstone disease (GD). We describe the development of four cases of symptomatic GD including a case of acute cholecystitis in Indian Antarctic expedition members during 1 year of polar residence and their response to 6 months of ursodeoxycholic acid (UDCA) therapy. Twenty subjects were evaluated at baseline and at serial intervals using clinical history, dietary assessment, anthropometry, blood investigations and ultrasonography for development of gallstone disease. Ursodeoxycholic acid and lipid lowering agents were prescribed as indicated and response to therapy measured over a period of 1 year in Antarctica. Four cases of cholesterol GD and two cases of biliary sludge were detected after 4 months. Dyslipidemia including hypertriglyceridemia in four of 20 cases (20%), hypercholesterolemia in nine of 20 cases (45%) and low high density lipoprotein (HDL) cholesterol in six of 20 cases (30%) was seen to develop after 3 months of polar residence. Impaired glucose tolerance was found in three of 20 cases (15%), two of whom developed gallstones. Ursodeoxycholic acid therapy completely dissolved gallstones in three cases and led to partial resolution in one case at 6 months. A trial of lipid lowering agents and 1 month of UDCA led to resolution of biliary sludge in both cases. Obesity, dyslipidemia, impaired glucose tolerance and high fat and caloric intake were found to increase the risk of developing cholesterol GD during the Antarctic expedition. Ursodeoxycholic acid therapy was found to be efficacious in dissolution of gallstones and prevention of formation of larger stones in cases with gall bladder sludge. The effect of geographical factors such as exposure to colder environments on the development of GD needs further research.