Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The cholesterol saturation index of human bile


A line of maximum cholesterol solubility was obtained by plotting the ratios of bile salt to cholesterolversus bile salt to phospholipid from model solutions simulating bile containing human biliary lecithin, human bile salts, and cholesterol. The sole factor responsible for the solubility of cholesterol (above the 3% total solid content) was found to be the proportion of bile salts to lecithin. This relationship could be expressed mathematically by a polynomial equation and the bile-salt-to-cholesterol ratio at maximum cholesterol holding capacity for a bile ascertained. From this information the percent cholesterol saturation of human bile could be determined. This method was applied to the bile obtained from 139 patients. The biles from 49 of 53 patients with known cholesterol gallstones had a cholesterol saturation index of 100% or greater, while 53 of 77 patients without evidence of cholesterol gallstones had a cholesterol-unsaturated bile. This method quantitates the exact degree of cholesterol saturation in human bile (cholesterol saturation index-CSI), and the availability of this index should be useful for diagnostic and therapeutic purposes.

This is a preview of subscription content, log in to check access.


  1. 1.

    Isaksson B: On the dissolving power of lecithin and bile salts for cholesterol in human bladder bile. Acta Soc Med Upps 59:296–306, 1954

  2. 2.

    Admirand WH, Small DM: The physicochemical basis of cholesterol gallstone formation in man. J Clin Invest 47:1043–1052, 1968

  3. 3.

    Hegardt FG, Dam H: The solubility of cholesterol in aqueous solutions of bile salts and lecithin. Z Ernaehrungswiss 10:223–233, 1971

  4. 4.

    Metzger AL, Heymsfield S, Grundy SM: The lithogenic index—a numerical expression for the relative lithogenicity of bile. Gastroenterology 62:499–501, 1972

  5. 5.

    Hirsch J, Ahrens EH Jr: The separation of complex lipide mixtures by the use of silicic acid chromatography. J Biol Chem 233:311–320, 1958

  6. 6.

    Folch J, Lees M, Sloane-Stanley GH: A simple method for the isolation and purification of total lipids from animal tissues. J Biol Chem 226:497–509, 1957

  7. 7.

    Vlahcevic ZR, Bell CC Jr, Juttijudata P, Swell L: Bile rich duodenal fluid as an indicator of biliary lipid composition and its applicability to the detection of lithogenic bile. Am J Dig Dis 16:797–802, 1971

  8. 8.

    Sperry W, Webb J: Revision of Schoenheimer-Sperry method for cholesterol determination. J Biol Chem 187:97–102, 1950

  9. 9.

    Bartlett GR: Phosphorus assay in column chromatography. J Biol Chem 234:466–468, 1959

  10. 10.

    Swell L: Gas Chromatography. New York, Grune and Stratton Inc, 1968, pp 97–109

  11. 11.

    Vlahcevic ZR, Miller JR, Farrar JT, Swell L: Kinetics and pool size of primary bile acids in man. Gastroenterology 61:85–90, 1971

  12. 12.

    Thistle JL, Schoenfield LJ: Lithogenic bile among young Indian women. Lithogenic potential decreased with chenodeoxycholic acid. N Engl J Med 284:177–181, 1971

  13. 13.

    Vlahcevic ZR, Bell CC Jr, Gregory DH, Buker G, Juttijudata P, Swell L: Relationship of bile acid pool size to the formation of lithogenic bile in female Indians of the Southwest. Gastroenterology 62:73–83, 1972

  14. 14.

    Bourges M, Small DM, Dervichian DG: Biophysics of lipid associations. III. The quaternary systems lecithin-bile salt-cholesterol-water. Biochim Biophys Acta 144:189–201, 1967

  15. 15.

    Neiderhiser DH, Roth HP: Cholesterol solubilization by solutions of bile salts and bile salts plus lecithin. Proc Soc Exp Biol Med 128:221–225, 1968

  16. 16.

    Montet JC, Dervichian DG: Solubilisation micellaire du cholesterol par les sels biliaires et les lecithines extraits de la bile humaine. Biochimie 53:751–754, 1971

  17. 17.

    Sampliner RE, Bennett PH, Comess LJ, Rose F, Burch TA: Gallbladder disease in Pima Indians. Demonstration of high prevalence and early onset by cholecystography. N Engl J Med 283:1358–1364, 1970

Download references

Author information

Correspondence to Leon Swell PhD.

Additional information

Supported in part by United States Public Health Service Research Grant 1R01-AM-14668-02 from the National Institute of Arthritis and Metabolic Disease, National Institutes of Health, United States Public Health Service.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Swell, L., Bell, C.C., Gregory, D.H. et al. The cholesterol saturation index of human bile. Digest Dis Sci 19, 261–265 (1974). https://doi.org/10.1007/BF01072543

Download citation


  • Public Health
  • Cholesterol
  • Lecithin
  • Bile Salt
  • Solid Content