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
Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent causes of liver disease in the United States. The prevalence of NAFLD is rising globally in line with the obesity epidemic. The pathophysiology of the development of NAFLD is rooted in metabolic derangement and insulin resistance. In addition, the development of gallstones shares several common risk factors with that of NAFLD. Cholecystectomy, a sequela of gallstone disease (GSD), may alter the metabolism of the enterohepatic circulation of bile acids and contribute to an increased risk of NAFLD.
There is a paucity of literature and data in terms of large-scale multicenter retrospective studies that have investigated an association between GSD and NAFLD.
To determine whether an association between GSD and NAFLD exists, identify the prevalence of multiple co-morbidities associated with NAFLD, and discuss risk factor modification for the prevention of the development of NAFLD in addition to halting its progression to end stage liver disease.
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 GSD as well as NAFLD. Odds ratios (ORs) measuring the association between GSD and NAFLD were calculated using logistic regression after adjusting for confounding variables.
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 confounders, 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 with 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).
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.
There is a need for further prospective studies and randomized clinical trials to evaluate the impact of gallstones and cholecystectomy on the development of NAFLD.