Published online Mar 22, 2021. doi: 10.4291/wjgp.v12.i2.14
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
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.
To determine whether there is a meaningful association between gallstones and cholecystectomy with NAFLD.
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.
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.
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.
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.