DEVELOPMENT OF LITHOGENIC BILE DURING PUBERTY IN PIMA-INDIANS

To determine whether highly saturated bile is a congenital or acquired characteristic of Pima Indians and to elucidate the basis of the rapid postpubertal increase in gallstones in Pimas, we studied the bile of 66 Pimas nine to 21 years of age. Highly saturated bile is not prevalent among Pimas under the age of 13, but bile saturation increases significantly (P<0.05) in both sexes during pubertal growth and development. Bile saturation was 15 per cent higher in females than males. Bile acid pools increased with age in the young men, but not in women. Bile cholesterol saturation correlated with obesity (r = 0.41; P<0.001) and urinary estrogen excretion (r = 0.44; P<0.001). Highly saturated bile may be present for several years before the onset of cholesterol cholelithiasis. (N Engl J Med 300:873–876, 1979) CHOLESTEROL gallstones are uncommon in childhood, but the prevalence of the disorder rises after puberty, with women showing a higher prevalence than men.1 2 3 4 5 6 7 8 To elucidate the basis of the postpubertal rise in cholesterol cholelithiasis and of the excess prevalence of gallstones among women, we studied the bile of early pubertal, intrapubertal and sexually adult young men and women of the Pima Indian tribe, a genetically and culturally homogeneous population with a high prevalence of gallstones.6,9 As in other populations, the prevalence of gallstones among Pimas in their mid-teen years is very low.6 By their mid-thirties, however, Pima women attain a. © 1979, Massachusetts Medical Society. All rights reserved.