Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Mar 22, 2021; 12(2): 14-24
Published online Mar 22, 2021. doi: 10.4291/wjgp.v12.i2.14
Association of non-alcoholic fatty liver disease with gallstone disease in the United States hospitalized patient population
Asim Kichloo, Shantanu Solanki, Khwaja F Haq, Dushyant Dahiya, Beth Bailey, Dhanshree Solanki, Jagmeet Singh, Michael Albosta, Farah Wani, Michael Aljadah, Harshil Shah, Hafiz Khan, Syed-Mohammed Jafri
Asim Kichloo, Dushyant Dahiya, Beth Bailey, Michael Albosta, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
Shantanu Solanki, Harshil Shah, Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Khwaja F Haq, Syed-Mohammed Jafri, Department of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202, United States
Dhanshree Solanki, Health Administration, Rutgers University, New Brunswick, NJ 08901, United States
Jagmeet Singh, Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Farah Wani, Family Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
Michael Aljadah, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Hafiz Khan, Department of Gastroenterology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Author contributions: Kichloo A and Solanki S are credited with substantial contribution to the design of the work, acquisition and interpretation of the data, drafting the manuscript, revision of important intellectual content, final approval of the version published, and agreement of accountability for all aspects of the work; Haq KF, Dahiya D and Solanki D are credited with substantial contribution to interpretation of data, literature review of all sections discussed, drafting of the manuscript, final approval of the version published, and agreement of accountability for all aspects of the work; Bailey B is credited with substantial contribution to acquisition, analysis, and interpretation of the data, revision of critically important intellectual content, final approval of the version to be published, and agreement of accountability for all aspects of the work; Singh J, Wani F, Albosta M and Aljadah M are credited with interpretation of the data, literature review of all sections, revision of important intellectual content, final approval of the version published, and agreement of accountability of all aspects of the work; Shah H, Khan H and Jafri SM are credited with interpretation of data, literature review, specifically for the discussion section, revision of the work for critically important intellectual content, final approval of the version published, and agreement of accountability for all aspects of the work.
Institutional review board statement: The study presented in the current manuscript, which utilizes data from the Health Cost and Utilization Project, meets all relevant ethical and regulatory standards. These data, which were received by the investigators completely deidentified, required a local data custodian, and all investigators who accessed the data completed HCUP appropriate data use training and signed data use agreements. As such, our use of the HCUP data met the Central Michigan University IRB policy that such data use is not human subjects research, and does not require their review or approval.
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the Supplementary Material.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Albosta, MD, Doctor, Department of Internal Medicine, Central Michigan University College of Medicine, 1000 Houghton Avenue, Saginaw, MI 48602, United States. albos1ms@cmich.edu
Received: November 27, 2020
Peer-review started: November 27, 2020
First decision: December 20, 2020
Revised: December 27, 2020
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: March 22, 2021
Abstract
BACKGROUND

Gallstones and cholecystectomy have been proposed as risk factors for non-alcoholic fatty liver disease (NAFLD). The reason for this may be that both gallstones, as well as NAFLD share several risk factors with regards to their development. Currently, there is a lack of sufficient evidence showing an association between these clinical conditions.

AIM

To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.

METHODS

We queried the National Inpatient Sample database from the years 2016 and 2017 using International Classification of Diseases, 10th revision, Clinical Modification diagnosis codes to identify hospitalizations with a diagnosis of gallstone disease (GSD) (includes calculus of gallbladder without cholecystitis without obstruction and acquired absence of gallbladder) as well as NAFLD (includes simple fatty liver and non-alcoholic steatohepatitis). Odds ratios (ORs) measuring the association between GSD (includes gallstones and cholecystectomy) and NAFLD were calculated using logistic regression after adjusting for confounding variables.

RESULTS

Out of 14294784 hospitalizations in 2016-2017, 159259 were found to have NAFLD. The prevalence of NAFLD was 3.3% in patients with GSD and 1% in those without. NAFLD was prevalent in 64.3% of women with GSD as compared to 35.7% of men with GSD. After controlling for various confounders associated with NAFLD and GSD, multivariate-adjusted analysis showed that there was an association between NAFLD with gallstones [OR = 6.32; 95% confidence interval (CI): 6.15-6.48] as well as cholecystectomy (OR = 1.97; 95%CI: 1.93-2.01). The association between NAFLD and gallstones was stronger in men (OR = 6.67; 95%CI: 6.42-6.93) than women (OR = 6.05; 95%CI: 5.83-6.27). The association between NAFLD and cholecystectomy was stronger in women (OR = 2.01; 95%CI: 1.96-2.06) than men (OR = 1.85; 95%CI: 1.79-1.92). P value was less than 0.001 for all comparisons.

CONCLUSION

NAFLD is more prevalent in women with GSD than men. The association between NAFLD and cholecystectomy/gallstones indicates that they may be risk factors for NAFLD.

Keywords: Gallstones, Non-alcoholic fatty liver disease, Gastroenterology, Hepatology, Non-alcoholic steatohepatitis, Cholecystectomy

Core Tip: We have identified a significant association between gallstone disease and non-alcoholic fatty liver disease. This association is stronger in women with gallstone disease than men. Further, this association is strongest in the Caucasian population. It is believed that this association is due to both physiologic changes post-cholecystectomy as well as the presence of metabolic derangement common to the development of both disorders. Lifestyle modification, including weight loss, dietary alterations, exercise, decreasing alcohol intake, and screening for the development of hepatic malignancy are important in preventing the development/progression of non-alcoholic fatty liver disease.