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Zhang Y, Zhang J, Yu D, Tu F, Liu J, Han B, Li B, Yuan Y, Chen C, Zhou M. Association between metabolic dysfunction associated steatotic liver disease and gallstones in the US population using propensity score matching. Sci Rep 2025; 15:910. [PMID: 39762481 PMCID: PMC11704231 DOI: 10.1038/s41598-025-85218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/01/2025] [Indexed: 01/11/2025] Open
Abstract
The novel diagnostic term Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) requires at least one cardiovascular risk factor for diagnosis. While the relationship between gallstones and Non-Alcoholic Fatty Liver Disease (NAFLD) has been debated, the association between MASLD and gallstones remains unclear. This cross-sectional study aimed to explore this relationship using National Health and Nutrition Examination Survey (NHANES) data from 2017 to 2020. Participants were stratified into two groups based on MASLD diagnosis, and propensity score matching (PSM) was employed to reduce biases. Of 15,560 participants, 7922 met the inclusion criteria, with 2697 (34.0%) diagnosed with MASLD. Gallstone prevalence was higher in the MASLD group (14.2%) compared to the non-MASLD group (8.5%). After PSM, 4536 participants were analyzed, revealing a significant association between MASLD and gallstones (OR = 1.30, 95% CI 1.09-1.56, P = 0.003). This association remained robust across crude and adjusted analyses, with subgroup and sensitivity analyses further supporting the findings. In conclusion, MASLD is significantly associated with an increased risk of gallstones in the US population. These findings highlight the need to consider this relationship in clinical strategies for prevention and management of gallstone disease.
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Affiliation(s)
- Yingying Zhang
- Department of Laboratory Medicine, The Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, 214005, China
| | - Jingjing Zhang
- Department of Medical Sonography, The Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, 214005, China
| | - Dan Yu
- Department of Laboratory Medicine, The Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, 214005, China
| | - Fan Tu
- Department of Laboratory Medicine, The Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, 214005, China
| | - Jun Liu
- Department of Laboratory Medicine, The Affiliated Wuxi Fifth Hospital of Jiangnan University, Wuxi, 214005, China
| | - Bing Han
- Department of Hepatobiliary and Transplantation Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Binghua Li
- Department of Hepatobiliary and Transplantation Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yihang Yuan
- Department of Colorectal Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Chaobo Chen
- Department of General Surgery, Xishan People's Hospital of Wuxi City, Wuxi, 214105, China.
| | - Mingli Zhou
- Department of General Surgery, The Affiliated Wuxi Fifth Hospital of Jiangnan University, No. 1215 Guangrui Road, Wuxi, 214005, Jiangsu, China.
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Jiang GH, Li S, Li HY, Xie LJ, Li SY, Yan ZT, Yu WQ, Luo J, Bai X, Kong LX, Lou YM, Zhang C, Li GC, Shan XF, Mao M, Wang X. Bidirectional associations among gallstone disease, non-alcoholic fatty liver disease, kidney stone disease. World J Gastroenterol 2024; 30:4914-4928. [PMID: 39679314 PMCID: PMC11612713 DOI: 10.3748/wjg.v30.i46.4914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 09/02/2024] [Accepted: 09/27/2024] [Indexed: 11/21/2024] Open
Abstract
BACKGROUND A body of evidence has suggested bidirectional relationships among gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and kidney stone disease (KSD). However, the results are inconsistent, and studies on this topic in China are relatively few. Our goal is to explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. AIM To explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. The results may help to investigate the etiology of these diseases and shed light on the individualized prevention of these three diseases. METHODS Subjects who participated in physical examinations in Beijing, Tianjin, Chongqing in China were recruited. Multivariable logistic regression was employed to explore the bidirectional relationships among GSD, KSD, and NAFLD. Systematic review and meta-analysis were initiated to confirm the epidemiologic evidence from previous observational studies. Furthermore, trial sequential analysis (TSA) was conducted to evaluate whether the evidence was sufficient and conclusive. RESULTS Significant bidirectional associations were detected among the three diseases, independent of potential confounding factors. The pooled results of the systematic review and meta-analysis also corroborated the aforementioned results. The combined evidence from the multicenter study and meta-analysis was significant [pooled odds ratio (OR) = 1.42, 95%CI: 1.16-1.75, KSD → GSD; pooled OR = 1.48, 95%CI: 1.31-1.67, GSD → KSD; pooled OR = 1.31, 95%CI: 1.17-1.47, GSD → NAFLD; pooled OR = 1.37, 95%CI: 1.26-1.50, NAFLD → GSD; pooled OR = 1.28, 95%CI: 1.08-1.51, NAFLD → KSD; pooled OR = 1.21, 95%CI: 1.16-1.25, KSD → NAFLD]. TSA indicated that the evidence was sufficient and conclusive. CONCLUSION The present study presents relatively sufficient evidence for the positive bidirectional associations among GSD, KSD, and NAFLD. The results may provide clues for investigating the etiology of these three diseases and offer a guideline for identifying high-risk patients.
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Affiliation(s)
- Guo-Heng Jiang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Sheng Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Yu Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Jun Xie
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shi-Yi Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zi-Tong Yan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Qian Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Luo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xuan Bai
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ling-Xi Kong
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan-Mei Lou
- Department of Health Management, Beijing Xiaotangshan Hospital, Beijing 102211, China
| | - Chi Zhang
- Department of Prevention, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Guang-Can Li
- Department of Pharmacy, The People’s Hospital of Kaizhou District, Chongqing 405400, China
| | - Xue-Feng Shan
- Department of Pharmacy, Bishan Hospital of Chongqing Medical University, Chongqing 402760, China
| | - Min Mao
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Slouha E, Biput SJ, Kuteyi A, Kalloo AE, Gorantla VR. Non-alcoholic Fatty Liver Disease and Gallstones: A Systematic Review. Cureus 2023; 15:e45027. [PMID: 37829934 PMCID: PMC10566311 DOI: 10.7759/cureus.45027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is steatosis of the liver that resembles alcohol-induced liver injury but is a metabolic disorder. Most patients are obese with increased triglyceride levels due to increased intake of fatty food, which can cause excess fat to build up in the liver. At the same time, continuous ingestion of fatty foods can lead to gallstones (GS) due to the overproduction of cholesterol. NAFLD and GS have been seen to coincide, and there might be a relationship between them. This systematic review analyzes the incidence of NAFLD and GS to determine a bidirectional relationship. A comprehensive literature review was done using ProQuest, PubMed, and ScienceDirect, and included only experimental studies and meta-analyses. The search included the keywords 'gallstones and non-alcoholic fatty liver disease' and 'cholelithiasis and non-alcoholic fatty liver disease'. Our initial search included 10,665 articles and was narrowed down to 19 through extensive inclusion and exclusion criteria. There is a bidirectional relationship between the incidence of NAFLD and GS, where an increase in either can lead to an increase in the other. Both NAFLD and GS share similar risk factors leading to the development of each disease. On average, there's an increase in the prevalence of gallstones in NAFLD patients, and patients with GS were also more likely to have NAFLD. There was a prevalence of NAFLD in those with asymptomatic gallstones as well, indicating that the risk factors are crucial in the development of both. As a result, some research is determining whether an evaluation of the liver should be routine during cholecystectomy due to the increased risk of developing NAFLD.
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Affiliation(s)
- Ethan Slouha
- Medical School, St. George's University School of Medicine, True Blue, GRD
| | - Stefan J Biput
- Medical School, St. George's University School of Medicine, True Blue, GRD
| | - Azeez Kuteyi
- Medical School, St. George's University School of Medicine, True Blue, GRD
| | - Amy E Kalloo
- Clinical Sciences, St. George's University, True Blue, GRD
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Ballestri S, Lonardo A. Ultrasonographic fatty liver indicator (US-FLI): a reliable biomarker for non-invasive NAFLD stratification. METABOLISM AND TARGET ORGAN DAMAGE 2023; 3. [DOI: 10.20517/mtod.2023.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Here, we comment on a recent article supporting the use of the ultrasonographic fatty liver indicator (US-FLI) as a point-of-care biomarker to be used in the community to rule out nonalcoholic steatohepatitis (NASH). To this end, we discuss definitions and characteristics of US-FLI, and we critically summarize the principal studies published from 2012 to 2023. We conclude that US-FLI exhibits high reproducibility. It finds utility across both the pediatric population and the point-of-care settings. Furthermore, it demonstrates a robust correlation with metabolic derangements, and also serves as a predictive tool for varying grades of hepatic steatosis and important liver histology endpoints. Notably, it excels in its capacity to differentiate between bland steatosis and true NASH. However, US-FLI reportedly exhibits limited accuracy among patient populations with obesity. Finally, we propose a detailed agenda to advance research on US-FLI.
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Ceci L, Han Y, Krutsinger K, Baiocchi L, Wu N, Kundu D, Kyritsi K, Zhou T, Gaudio E, Francis H, Alpini G, Kennedy L. Gallstone and Gallbladder Disease: Biliary Tract and Cholangiopathies. Compr Physiol 2023; 13:4909-4943. [PMID: 37358507 DOI: 10.1002/cphy.c220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Cholestatic liver diseases are named primarily due to the blockage of bile flow and buildup of bile acids in the liver. Cholestasis can occur in cholangiopathies, fatty liver diseases, and during COVID-19 infection. Most literature evaluates damage occurring to the intrahepatic biliary tree during cholestasis; however, there may be associations between liver damage and gallbladder damage. Gallbladder damage can manifest as acute or chronic inflammation, perforation, polyps, cancer, and most commonly gallstones. Considering the gallbladder is an extension of the intrahepatic biliary network, and both tissues are lined by biliary epithelial cells that share common mechanisms and properties, it is worth further evaluation to understand the association between bile duct and gallbladder damage. In this comprehensive article, we discuss background information of the biliary tree and gallbladder, from function, damage, and therapeutic approaches. We then discuss published findings that identify gallbladder disorders in various liver diseases. Lastly, we provide the clinical aspect of gallbladder disorders in liver diseases and ways to enhance diagnostic and therapeutic approaches for congruent diagnosis. © 2023 American Physiological Society. Compr Physiol 13:4909-4943, 2023.
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Affiliation(s)
- Ludovica Ceci
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Yuyan Han
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | - Kelsey Krutsinger
- School of Biological Sciences, University of Northern Colorado, Greeley, Colorado, USA
| | | | - Nan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Debjyoti Kundu
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Konstantina Kyritsi
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tianhao Zhou
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Heather Francis
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Gianfranco Alpini
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Lindsey Kennedy
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Research, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Gu S, Hu S, Wang S, Qi C, Shi C, Fan G. Bidirectional association between NAFLD and gallstone disease: a systematic review and meta-analysis of observational studies. Expert Rev Gastroenterol Hepatol 2023; 17:283-293. [PMID: 36726224 DOI: 10.1080/17474124.2023.2175671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Growing evidence indicates an association between NAFLD and gallstone disease (GD), while some does not support this. The aim of this meta-analysis was to evaluate the bidirectional association between NAFLD and GD. RESEARCH DESIGN AND METHODS Five electronic databases were searched from inception to May 2022. The association was analyzed based on the odds ratio (OR) and 95% confidence interval (CI) with Reviewer Manager 5.3. RESULTS Ten studies involving 284,512 participants met the criteria for GD predicting the onset of NAFLD. GD patients had a higher incidence of NAFLD (OR:1.48, CI:1.32-1.65, p < 0.00001), especially the incidence of moderate-to-severe NAFLD (OR:1.63; CI:1.40-1.79), with females at a higher risk (OR: 1.84; CI: 1.48-2.29). The inverse association was explored in eight studies involving 326,922 participants. The GD incidence in NAFLD patients was higher (OR:1.71, CI:1.63-1.79, p < 0.00001) and may increase due to female sex (OR: 4.18; CI: 1.21-14.37) and high BMI (OR: 1.80; CI: 1.36-2.56), compared with the non-NAFLD group. Besides, this bidirectional association was also confirmed in the Chinese population. CONCLUSIONS The findings supported positive concurrent and bidirectional relationships between NAFLD and GD. Therefore, clinicians may alert the possibility of NAFLD in patients with GD and vice versa.
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Affiliation(s)
- Shengying Gu
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Shanshan Hu
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Shuowen Wang
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Chendong Qi
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Chenyang Shi
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Guorong Fan
- Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
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Lyu J, Lin Q, Fang Z, Xu Z, Liu Z. Complex impacts of gallstone disease on metabolic syndrome and nonalcoholic fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:1032557. [PMID: 36506064 PMCID: PMC9727379 DOI: 10.3389/fendo.2022.1032557] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with gallstone disease (GSD) often have highly co-occurrence with metabolic syndrome (MetS) and Nonalcoholic fatty liver disease (NAFLD) both associated with insulin resistance (IR). Meanwhile, highly prevalence of NAFLD was found in patients who received cholecystectomy. However, the associations of GSD with MetS, NAFLD is inconsistent in the published literature. And risk of cholecystectomy on NAFLD is unclear. METHODS We searched the Medline EMBASE and WOS databases for literature that met our study topic. To be specific, studies with focus on associations between GSD and MetS/NAFLD, and risk evaluation on cholecystectomy and NAFLD incidence were enrolled for further analysis. The random effect model was used to calculate the combined relative ratio (RR) and odds ratio (OR)and 95% confidence interval (CI). RESULTS Seven and six papers with focus on connections between GSD and NAFLD/MetS prevalence. Correspondingly, seven papers with focus on risk of cholecystectomy on NAFLD occurrence were also enrolled into meta-analysis. After pooling the results from individual study, patients with GSD had higher risk of MetS (OR:1.45, 95%CI: 1.23-1.67, I2 = 41.1%, P=0.165). Risk of GSD was increased by 52% in NAFLD patients (pooled OR:1.52, 95%CI:1.24-1.80). And about 32% of increment on NAFLD prevalence was observed in patients with GSD (pooled OR: 1.32, 95%CI:1.14-1.50). With regard to individual MetS components, patients with higher systolic blood pressure were more prone to develop GSD, with combined SMD of 0.29 (96%CI: 0.24-0.34, P<0.05). Dose-response analysis found the GSD incidence was significantly associated with increased body mass index (BMI) (pooled OR: 1.02, 95%CI:1.01-1.03) in linear trends. Patients who received cholecystectomy had a higher risk of post-operative NAFLD (OR:2.14, 95%CI: 1.43-2.85), P<0.05). And this impact was amplified in obese patients (OR: 2.51, 95%CI: 1.95-3.06, P<0.05). CONCLUSION Our results confirmed that controls on weight and blood pressure might be candidate therapeutic strategy for GSD prevention. And concerns should be raised on de-novo NAFLD after cholecystectomy.
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Affiliation(s)
- Jingting Lyu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Qinghong Lin
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhongbiao Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zeling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhengtao Liu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Shulan (Hangzhou) Hospital, Hangzhou, China
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Rodríguez-Antonio I, López-Sánchez GN, Reyes-Gómez VA, Contreras-Flores EH, Farías-García F, Espejel-Deloiza M, Durán-Padilla MA, Chablé-Montero F, Uribe M, Chávez-Tapia NC, Montalvo-Javé EE, Nuño-Lámbarri N. Laparoscopic cholecystectomy: Histopathological analysis of metabolic associated fatty liver disease and fibrosis. Ann Hepatol 2022; 27:100651. [PMID: 34896638 DOI: 10.1016/j.aohep.2021.100651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Metabolic (dysfunction) associated fatty liver disease (MAFLD) and cholelithiasis are highly prevalent and are associated with common risk factors such as obesity, hypertriglyceridemia, and fasting glucose levels; however, it is not clear whether cholelithiasis is associated with MAFLD or fibrosis. OBJECTIVE To determine MAFLD severity and associated risk factors in patients diagnosed with cholelithiasis. MATERIALS AND METHODS Observational, cross-sectional and prolective study (from October 2018 to March 2020) of patients undergoing elective laparoscopic cholecystectomy with liver biopsy, excluding other causes of hepatic disease or significant alcohol consumption. MAFLD detection was based on histology using the Kleiner score and one of the following criteria: overweight/obesity, T2DM, or evidence of metabolic dysregulation. The AST to Platelet Ratio Index, the NAFLD Fibrosis Score, the fibrosis-4 index and the hepatic steatosis index were performed to assess the relationship of non-invasive hepatic scores with histopathology. RESULTS 80 patients median age (interquartile range) was 42 (18) years, with a BMI of 27.9 (6.11) Kg/m2. Of all patients, 58.8% had MAFLD, 78.7% were women, and 13.8% had the severe form (formerly named NASH). No substantial correlation between biochemical parameters and histopathological analysis of MAFLD and fibrosis was observed. CONCLUSION Because cholelithiasis and MAFLD are highly prevalent diseases, it is essential to conduct studies on the relationship between both pathologies. Currently, liver biopsy is the best diagnostic method since the predictive biochemical models did not show a substantial correlation to classify MAFLD. Its early detection is relevant since a considerable percentage of advanced fibrosis (8.7%) was found.
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Affiliation(s)
- Itzayana Rodríguez-Antonio
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico
| | - Guillermo N López-Sánchez
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico
| | - Víctor A Reyes-Gómez
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Ericka H Contreras-Flores
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Fernanda Farías-García
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Mariana Espejel-Deloiza
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico
| | - Marco A Durán-Padilla
- Surgical Pathology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050 Mexico City, Mexico for Dr. Eduardo E. Montolvo-Javé
| | - Norberto C Chávez-Tapia
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050 Mexico City, Mexico for Dr. Eduardo E. Montolvo-Javé
| | - Eduardo E Montalvo-Javé
- Hepato Pancreato and Biliary Surgery, Department of General Surgery, Hospital General de Mexico, Dr. Eduardo Liceaga, Faculty of Medicine, UNAM, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Mexico City, Mexico.
| | - Natalia Nuño-Lámbarri
- Traslational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra. Tlalpan, 14050 Mexico City, Mexico.
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Xie ZQ, Li HX, Tan WL, Yang L, Ma XW, Li WX, Wang QB, Shang CZ, Chen YJ. Association of Cholecystectomy With Liver Fibrosis and Cirrhosis Among Adults in the USA: A Population-Based Propensity Score-Matched Study. Front Med (Lausanne) 2021; 8:787777. [PMID: 34917640 PMCID: PMC8669563 DOI: 10.3389/fmed.2021.787777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Cholecystectomy is the “gold standard” for treating diseases of the gallbladder. In addition, non-alcoholic fatty liver disease (NAFLD), liver fibrosis or cirrhosis, are major causes of morbidity and mortality across the world. However, the association between cholecystectomy and these diseases is still unclear. We assessed the association among US adults and examined the possible risk factors. Methods: This cross-sectional study used data from 2017 to 2018 National Health and Nutrition Examination Survey, a population-based nationally representative sample of US. Liver fibrosis and cirrhosis were defined by median stiffness, which was assessed by transient elastography. Furthermore, patients who had undergone cholecystectomy were identified based on the questionnaire. In addition, Propensity Score Matching (PSM, 1:1) was performed based on gender, age, body mass index (BMI) and diabetes. Results: Of the 4,497 included participants, cholecystectomy was associated with 60.0% higher risk of liver fibrosis (OR:1.600;95% CI:1.278–2.002), and 73.3% higher risk of liver cirrhosis (OR:1.733, 95% CI:1.076–2.792). After PSM based on age, gender, BMI group and history of diabetes, cholecystectomy was associated with 139.3% higher risk of liver fibrosis (OR: 2.393;95% CI: 1.738–3.297), and 228.7% higher risk of liver cirrhosis (OR: 3.287, 95% CI: 1.496–7.218). Conclusions: The present study showed that cholecystectomy is positively associated with liver fibrosis and cirrhosis in US adults. The discovery of these risk factors therefore provides new insights on the prevention of NAFLD, liver fibrosis, and cirrhosis.
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Affiliation(s)
- Zhi-Qin Xie
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong-Xia Li
- Department of Pathology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Wen-Liang Tan
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Yang
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Wu Ma
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen-Xin Li
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Qing-Bin Wang
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang-Zhen Shang
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Chang-Zhen Shang
| | - Ya-Jin Chen
- Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Ya-Jin Chen
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Lu Y, Hu L, Song J, Wan J, Chen H, Yin J. Gallstone disease and nonalcoholic fatty liver disease in patients with type 2 diabetes: a cross-sectional study. BMC Endocr Disord 2021; 21:231. [PMID: 34794397 PMCID: PMC8603504 DOI: 10.1186/s12902-021-00899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) often coexist in the general population owing to shared risk factors. This study explored the relationship between NAFLD and GSD in patients with type 2 diabetes. METHODS We conducted a retrospective cross-sectional analysis of 4325 patients with type 2 diabetes. GSD and NAFLD were confirmed using ultrasonography. GSD was defined as either asymptomatic gallstones or previous cholecystectomy, and each was analyzed separately. RESULT There was no significant difference in the prevalence of GSD between patients with and without NAFLD (23.8% vs. 21.2%, P = 0.15). After case-control matching (1:1) of baseline data such as age, sex, duration of diabetes, and HbA1c between patients with and without NAFLD, there was still no significant difference in the prevalence of GSD (25.5% vs. 23.6%, P = 0.15). The prevalence of NAFLD in patients with asymptomatic gallstones was lower than that of patients without GSD (38.6% vs. 47.3%, P < 0.001), whereas the prevalence in those who had undergone cholecystectomy was much higher (61.2% vs. 47.3%, P < 0.001). The ratio of cholecystectomy to asymptomatic gallstone in patients with or without NAFLD was 1.97 and 0.79, respectively. The rate of cholecystectomy was higher in the patients with NAFLD than in those without NAFLD (15.8% vs. 9.3%, P < 0.001), consistent with the result after case-control matching (17.3% vs. 11.2%, P < 0.001). Multivariate logistic regression analysis, after adjusting for numerous potential confounding factors, revealed that GSD (OR = 1.241, 95%CI: 1.036-1.488, P = 0.002) and cholecystectomy (OR = 1.946, 95%CI: 1.546-2.445, P < 0.001) were both strongly associated with NAFLD. However, asymptomatic gallstone (OR = 0.663, 95%CI: 0.513-0.856, P = 0.002) seemed to be negatively correlated with NAFLD. CONCLUSIONS The prevalence of GSD was similar in patients with type 2 diabetes with and without NAFLD. The higher proportion of cholecystectomy and lower proportion of asymptomatic gallstones in patients with NAFLD suggests that NAFLD may increase the risk of complications of GSD.
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Affiliation(s)
- Ye Lu
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Lili Hu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai, 200233, China
| | - Jing Song
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Jing Wan
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, Shanghai, 200072, China.
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China.
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai, 200233, China.
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11
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Xu X, Wang W, Zhang Q, Cai W, Wu M, Qin T, Liu H. A Generic Nomogram Predicting the Stage of Liver Fibrosis Based on Serum Biochemical Indicators Among Chronic Hepatitis B Patients. Front Med (Lausanne) 2021; 8:669800. [PMID: 34616750 PMCID: PMC8488358 DOI: 10.3389/fmed.2021.669800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: Liver fibrosis staging is of great importance for reducing unnecessary injuries and prompting treatment in chronic viral hepatitis B patients. Liver biopsy is not suitable to act a screening method although it is a gold standard because of various shortcomings. This study aimed to establish a predictive nomogram as a convenient tool to effectively identify potential patients with different stages of liver fibrosis for patients with chronic hepatitis B. Methods: A nomogram for multinomial model was developed in a training set to calculate the probability for each stage of fibrosis and tested in a validation set. Fibrosis stages were subgrouped as followed: severe fibrosis/cirrhosis (F3–F4), moderate fibrosis (F2), and nil-mild fibrosis (F0–F1). The indicators were demographic characteristics and biochemical indicators of patients. Continuous indicators were divided into several groups according to the optimal candidate value generated by the decision tree. Results: This study recruited 964 HBV patients undergoing percutaneous liver biopsy. The multinomial model with 10 indicators was transformed into the final nomogram. The calibration plot showed a good agreement between nomogram-predicted and observed probability of different fibrosis stages. Areas under the receiver operating characteristics (AUROCs) for severe fibrosis/cirrhosis were 0.809 for training set and 0.879 for validation set. For moderate fibrosis, the AUROCs were 0.75 and 0.781. For nil-mild fibrosis, the AUROCs were 0.792 and 0.843. All the results above showed great predictive performance in predicting the stage of fibrosis by our nomogram. Conclusion: Our model demonstrated good discrimination and extensibility in internal and external validation. The proposed nomogram in this study resulted in great reliability and it can be widely used as a convenient and efficient way.
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Affiliation(s)
- Xueying Xu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Wusheng Wang
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Qimeng Zhang
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Weijie Cai
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Mingcheng Wu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Tiantian Qin
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Hongbo Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, China
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Parra-Landazury NM, Cordova-Gallardo J, Méndez-Sánchez N. Obesity and Gallstones. Visc Med 2021; 37:394-402. [PMID: 34722722 PMCID: PMC8543292 DOI: 10.1159/000515545] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prevalence of obesity has been increasing globally and represents the main risk factor for the development of gallstone disease (GD). SUMMARY Excess body weight represents the main cause for the development of GD; nevertheless, there have been described multiple risk factors for its development, among them modifiable risk factors as diet, lifestyle, physical inactivity, and non-modifiable risk factors as ethnicity, female sex, advanced age, parity, and genetic mutations. Body mass index, abdominal perimeter, and waist-hip index have been used to determine the degree of adiposity of a person. Hence, central abdominal fat has been mostly associated with insulin resistance with the consequent increase in the hepatic cholesterol secretion; contributing as one of the multiple mechanisms associated with the development of gallstones. This disease has a low mortality; however, it has been associated with multiple diseases such as cardiovascular diseases, carotid atherosclerosis, metabolic associated fatty liver disease, and gallbladder cancer, probably because they share many of the risk factors. KEY MESSAGES GD continues to be considered a disease with a high medical burden, in which it is sought to intervene in modifiable risk factors to reduce its development.
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Affiliation(s)
| | - Jacqueline Cordova-Gallardo
- Department of Hepatology, Service of Surgery and Obesity Clinic, General Hospital “Dr. Manuel Gea González”, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Nahum Méndez-Sánchez
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Liver Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
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13
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Qi L, Dai W, Kong J, Tian Y, Chen Y. Cholecystectomy as a risk factor for metabolic dysfunction-associated fatty liver disease: unveiling the metabolic and chronobiologic clues behind the bile acid enterohepatic circulation. J Physiol Biochem 2021; 77:497-510. [PMID: 34302623 DOI: 10.1007/s13105-020-00782-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/23/2020] [Indexed: 02/08/2023]
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent worldwide. Recent clinical and experimental studies have addressed the association between cholecystectomy and MAFLD, confirming that cholecystectomy is an independent risk factor for MAFLD. In this review, we describe the epidemiologic evidence that links cholecystectomy to MAFLD, and discuss the possible mechanisms behind these connections, in order to unveil the metabolic and chronobiologic signals conveyed by the waves of the bile acid enterohepatic circulation.
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Affiliation(s)
- Li Qi
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, No. 39, Hua xiang Road, Tiexi District, Shenyang, 110022, Liaoning Province, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, No. 77, Pu He Road, Shenbeixin District, Shenyang, 110004, Liaoning Province, China
| | - Jing Kong
- Department of General Surgery, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yu Tian
- Department of General Surgery, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yongsheng Chen
- Department of General Surgery, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
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Rodríguez-Antonio I, López-Sánchez GN, Garrido-Camacho VY, Uribe M, Chávez-Tapia NC, Nuño-Lámbarri N. Cholecystectomy as a risk factor for non-alcoholic fatty liver disease development. HPB (Oxford) 2020; 22:1513-1520. [PMID: 32773176 DOI: 10.1016/j.hpb.2020.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/12/2019] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic steatosis and gallstone disease are highly prevalent in the general population; the shared risk factors are age, ethnicity, obesity, insulin resistance, metabolic syndrome, atherosclerosis, risk of cardiovascular disease, and mortality. The presence of insulin resistance is the critical element in this association because it represents a crucial link between metabolic syndrome and non-alcoholic fatty liver disease, as well as a higher susceptibility to gallstone formation. METHODS An exhaustive search engine investigation of gallstone disease, cholecystectomy, and liver steatosis latest literature was made. RESULTS Clinical studies and systematic reviews suggest an association between gallstone disease, cholecystectomy, and hepatic steatosis. CONCLUSION The bidirectional relationship between liver steatosis and gallstone disease and cholecystectomy is summarized in the role of insulin resistance, lipid metabolism, bile acids signaling pathways regulated by transcription factors expression, and to the gallbladder physiological role; however, more epidemiological and experimental studies should be complemented.
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Affiliation(s)
- Itzayana Rodríguez-Antonio
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; School of Medicine, Benemérita Universidad Autónoma de Puebla, 13 Sur 2702, Los Volcanes, Z.C. 72420, Puebla, Mexico
| | - Guillermo N López-Sánchez
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Victor Y Garrido-Camacho
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Norberto C Chávez-Tapia
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico; Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico
| | - Natalia Nuño-Lámbarri
- Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra Tlalpan, Z.C. 14050, Mexico City, Mexico.
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15
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Cherkashchenko NA, Livzan MA, Krolevets TS. [Clinical features of the comorbid course of non-alcoholic fatty liver disease and gallstone disease]. TERAPEVT ARKH 2020; 92:29-36. [PMID: 33346459 DOI: 10.26442/00403660.2020.08.000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 12/14/2022]
Abstract
AIM To determine the diagnostic value of clinical features of the comorbid course of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GD) to improve the effectiveness of patient management. MATERIALS AND METHODS 183 patients with NAFLD were included into the open comparative study. The main group was represented by patients with NAFLD and GD (n=88), of which 53 patients underwent cholecystectomy (CE). The comparison group was represented by patients with NAFLD without GD (n=95). A standard laboratory and instrumental examinations were performed, including elastometry to assess of the stage of liver fibrosis. RESULTS There were more women in the main group (2=8.48; p0.01). There were positive correlations between the age of patients and the duration of NAFLD with the presence of GD and CE (rs=0.135; p0.01 and rs=0.168; p0.01 respectively). Patients of the main group had the general weakness and fatigue (2=11.33, rs=0.234; p0.01 and 2=15.68, rs=0.281; p0.01 respectively), as well as a bitter taste in the mouth (2=11.66; p0.01; rs=0.147; p0.01). Coronary heart disease was diagnosed more often among people suffering from NAFLD and GD (25% vs 9.47% in patients of the comparison group, p0.01). Both of NAFLD and GD were associated with the development of type 2 diabetes (rs=0.164; p0.01). Individuals suffering from GD after CE had higher LDL and GGT values (rs=0.228; p0.01 and rs=0.298; p0.01 respectively). The number of people with advanced fibrosis were significantly higher (26.31%) in the GD group, especially among people after CE (30.18%). The stage of liver fibrosis had a positive significant relationship with CE (rs=0.366; p0.01). CONCLUSION Patients suffering from GD and NAFLD had a symptom of dyspepsia and general weakness. High prevalence of type 2 diabetes and сoronary heart disease, high level of LDL and GGT were found in patients with GD and after CE. CE in patients suffering from GD and NAFLD was associated with the formation of progressive stages of liver fibrosis.
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Sepehrimanesh M, Niknam R, Ejtehadi F, Fattahi MR, Safarpour A. Association Between Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome with Gallstone Disease, South Iran: A Population-Based Study. Diabetes Metab Syndr Obes 2020; 13:1449-1458. [PMID: 32431528 PMCID: PMC7200259 DOI: 10.2147/dmso.s246949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
AIM Gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and metabolic syndrome (MetS) are common problems. The aim of this study was to investigate the association between NAFLD, MetS and its components with GSD. MATERIALS AND METHODS This cross-sectional study was conducted as a part of the Kavar Cohort Study (KCS) affiliated to Shiraz University of Medical Sciences, Shiraz, Iran between January 2012 and January 2018. A total of 2239 participants of the general population of the KCS were selected randomly. Ultrasonography for GSD and NAFLD diagnosis and clinical and laboratory assaying for MetS evaluation were performed for the participants. The National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) and Criteria for Clinical Diagnosis of MetS in Iranian Adults (CCDMIA) were used for diagnosis of MetS. RESULTS Overall, 59 patients with GSD and 177 age- and sex- matched participants without gallstones as a comparison group were enrolled. According to GSD groups, NAFLD was observed in 42.4% and 22.6% of patients with and without GSD, respectively, and the difference between the two groups was statistically significant (P = 0.003). MetS was present in 33.9% and 39.0% of GSD subjects, compared with 32.8% and 33.3% of the non-GSD group, based on NCEP/ATPIII and CCDMIA, respectively. Although the mean of all components of MetS except HDL-cholesterol were higher in the GSD group than in the non-GSD group, the difference was only significant in waist circumference (P = 0.041). CONCLUSION The present study found an obvious association between NAFLD and GSD. This study also showed a significant association between increasing waist circumference and risk of GSD. We recommend that patients with GSD should be evaluated for the likelihood of NAFLD and its treatment in addition to lifestyle changes to gain proper weight. However, further researches are needed to clarify the relationship between the nature of GSD, NAFLD, and obesity.
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Affiliation(s)
- Masood Sepehrimanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardad Ejtehadi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Cherkashchenko NA, Livzan MA, Krolevets TS. [Features of the course of gallstone disease in patients with non-alcoholic fatty liver disease]. TERAPEVT ARKH 2020; 92:48-54. [PMID: 32598718 DOI: 10.26442/00403660.2020.02.000550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/12/2023]
Abstract
AIM To update information about comorbidity of non-alcoholic fatty liver disease (NAFLD) and gallstones disease (GD), evaluation of clinical and laboratory data, including insulin, leptin and adiponectin in individuals with NAFLD in combination with GD. MATERIALS AND METHODS According to the design, we conducted an open comparative study of 169 patients with NAFLD. The following comparison groups were formed: group 1 (n=95) patients with NAFLD without GD, group 2 (n=35) patients with NAFLD and GD and group 3 (n=39) patients with NAFLD, GD and previous cholecystectomy. RESULTS A high prevalence of coronary heart disease was found in the group of patients with GD and cholecystectomy (2=6.198,p0.05); positive, statistically significant correlation relationships of cholelithiasis, cholecystectomy with ischemic heart disease (rs=0.172,p0.05 andrs=0.241,p0.05, respectively). There was a statistically significant decrease in total bilirubin and total protein in patients of group 3 (H=7.376,p0.03 and H=6.345,p0.04). The level of leptin is statistically significantly higher and positively interrelated with cholecystectomy (H=5.812,p0.05,rs=0.313,p0.05). CONCLUSION Patients with NAFLD, GD and previous cholecystectomy have a high prevalence of coronary heart disease; the phenomenon of insulin and leptin resistance, high level of adiponectin were revealed in patients with NAFLD and gallstones; hyperleptinemia was observed among patients with NAFLD, GD after cholecystectomy.
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Alsaif FA, Alqahtani SH, Alsadoon AM, Alswat KA, Abdo AA, Hassanain MM, Alsharabi AB, Aljuhani GR, Alkhalidi HM, Elsharkawy MS, Alotaibi MA, Sanai FM, Al-hamoudi WK. Prevalence of biopsy-proven nonalcoholic fatty liver among patients with gallstone disease. Saudi J Gastroenterol 2020; 26:282502. [PMID: 32341228 PMCID: PMC7580734 DOI: 10.4103/sjg.sjg_29_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Gallstone disease (GD) and nonalcoholic fatty liver disease (NAFLD) are associated with metabolic syndrome. Despite the benign nature of NAFLD, 10% of patients may develop advanced fibrosis and cirrhosis. We aimed to identify the prevalence and factors associated with NAFLD among GD patients in the Saudi population. PATIENTS AND METHODS This is a single-center, observational cohort study that included patients seen in general surgery clinics at our institution from 2011 to 2017. All liver biopsies were taken at the same time as the cholecystectomy. Demographical and clinical data were prospectively collected from the study population. RESULTS Of the 301 GD patients in the study, 15% had a normal body mass index (BMI), 29% were overweight, and 56% were obese. There were 143 (47.8%) patients with NAFLD, of which 125 (41.8%) showed steatosis and 18 (6%) had nonalcoholic steatohepatitis. There was a significant positive correlation between NAFLD and age (r = 0.243; P < 0.0001), and BMI (r = 0.242; P < 0.0001). Obese patients with BMI 30-40 kg/m[2] were 2.403 (P = 0.039) more likely to have NAFLD compared with normal BMI patients, and this value increased to 6.145 (P = 0.002) in patients with BMI >40 kg/m[2]. Additionally, patients with T2DM were 2.839 times (P = 0.015) more likely to have NAFLD compared with those who did not. CONCLUSIONS The prevalence of NAFLD among GD patients is high. High BMI and diabetes are independent factors associated with NAFLD in GD patients. The results suggest that there may be a need for routine liver biopsy in selected patients during cholecystectomy.
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Affiliation(s)
- Faisal A. Alsaif
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sara H. Alqahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amani M. Alsadoon
- Liver Disease Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid A. Alswat
- Liver Disease Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ayman A. Abdo
- Liver Disease Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mazen M. Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulsalam B. Alsharabi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ghadeer R. Aljuhani
- Department of Surgery, King Salman Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hisham M. Alkhalidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad S. Elsharkawy
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Maram A. Alotaibi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Faisal M. Sanai
- Department of Medicine, Gastroenterology Unit, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - Waleed K. Al-hamoudi
- Liver Disease Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Liver Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Bueverov AO. Clinical and Pathogenetic Parallels of Nonalcoholic Fatty Liver Disease and Gallstone Disease. ACTA ACUST UNITED AC 2019. [DOI: 10.22416/1382-4376-2019-29-1-17-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim:to analyze the data that has so far been accumulated on the pathogenetic association of gallstone disease (GD) and non-alcoholic fatty liver disease (NAFLD), as well as to assess the effect of cholecystectomy on the NAFLD course.Key findings.The relationship between GD and NAFLD is very complex and seems to be mutually aggravating. There is no doubt that there is an increased risk of GB in NAFLD patients, which is primarily associated with common pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (liver X-receptor and farnesoid X-receptor) and the bile acid membrane receptors (TGR5). Conversely, the effect of GD on the NAFLD course is assumed, although the pathogenetic factors of this association are still unknown. In recent years, convincing data has emerged concerning the role of cholecystectomy in the NAFLD progression, which may be connected with the development of small intestinal bacterial overgrowth, as well as with the disruption of the endocrine balance and the signal function of bile acids.Conclusion.The connection between NAFLD, GD and cholecystectomy is complex and multifaceted. The study of this connection will allow new methods of treatment to be developed.
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Affiliation(s)
- Aleksey O. Bueverov
- I.M. Sechenov First Moscow State Medical University (Sechenov University); M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
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Nonalcoholic fatty liver disease, cholesterol gallstones, and cholecystectomy: new insights on a complex relationship. Curr Opin Gastroenterol 2018; 34:90-96. [PMID: 29266009 DOI: 10.1097/mog.0000000000000416] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Gallstone disease (GSD) and nonalcoholic fatty liver disease (NAFLD often coexist in a given patient and both conditions are associated to obesity and insulin resistance. The relationship between GSD and NAFLD is complex and bidirectional. In the present review, we summarize the existing information on the complex link between GSD and NAFLD and the potential implications for patient care. RECENT FINDINGS Several clinical studies and systematic reviews have addressed the association between NAFLD and GSD underscoring that NAFLD is an independent risk factor for GSD. Conversely, GSD has been found also to be an independent risk factor for NAFLD with GSD potentially being linked to greater disease severity. In addition to the data showing association of NAFLD and GSD, recent evidence has also showed that cholecystectomy may itself be a risk factor for NAFLD development. The complex and bidirectional relationship between these diseases is partially explained by a number of common pathogenic links but the precise underlying mechanisms of the association of GSD and NAFLD need to be better delineated. Also, although the mechanisms of the promotional effect of cholecystectomy on NAFLD development are unknown, recent findings unveiling new aspects of gallbladder physiology and endocrine actions of bile acids provide a framework to advance research in this field. SUMMARY In this review, we address the different aspects of the complex association between NAFLD and GSD. The potential underlying mechanisms and recent information on endocrine actions of bile acids and the gallbladder are reviewed.
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Gallstones in Patients with Chronic Liver Diseases. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9749802. [PMID: 28251162 PMCID: PMC5306972 DOI: 10.1155/2017/9749802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022]
Abstract
With prevalence of 10-20% in adults in developed countries, gallstone disease (GSD) is one of the most prevalent and costly gastrointestinal tract disorders in the world. In addition to gallstone disease, chronic liver disease (CLD) is also an important global public health problem. The reported frequency of gallstone in chronic liver disease tends to be higher. The prevalence of gallstone disease might be related to age, gender, etiology, and severity of liver disease in patients with chronic liver disease. In this review, the aim was to identify the epidemiology, mechanisms, and treatment strategies of gallstone disease in chronic liver disease patients.
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Colak Y, Bozbey G, Erim T, Caklili OT, Ulasoglu C, Senates E, Mutlu HH, Mesci B, Doğan MS, Tasan G, Enc FY, Tuncer I. Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease. J Neurogastroenterol Motil 2016; 22:470-6. [PMID: 26932908 PMCID: PMC4930302 DOI: 10.5056/jnm15159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/22/2015] [Accepted: 01/29/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. METHODS An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. RESULTS Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. CONCLUSIONS Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.
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Affiliation(s)
- Yasar Colak
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.,Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA
| | - Gulcin Bozbey
- Department of Radiology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Tolga Erim
- Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA
| | - Ozge Telci Caklili
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Celal Ulasoglu
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Hasan Huseyin Mutlu
- Department of Family of Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Banu Mesci
- Department of Internal Medicine, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Mehmet Sait Doğan
- Department of Radiology, Erciyes University, School of Medicine, Kayseri, Turkey
| | - Guralp Tasan
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Feruze Yilmaz Enc
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ilyas Tuncer
- Department of Gastroenterology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
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Diagnostic usefulness of FibroMeter VCTE for hepatic fibrosis in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:1149-53. [PMID: 26049712 DOI: 10.1097/meg.0000000000000409] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver fibrosis is an important prognostic determinant in patients with nonalcoholic fatty liver disease (NAFLD). The FibroMeter VCTE is a diagnostic tool comprising both biochemical markers and transient elastography (TE) originally developed for the diagnosis of fibrosis in patients with chronic viral hepatitis. In this pilot study, we investigated the diagnostic performance of the FibroMeter VCTE tool for determining fibrosis in patients with biopsy-proven NAFLD. Its diagnostic accuracy was also compared with those of the NAFLD fibrosis score (NFSA) and TE alone. PATIENTS AND METHODS FibroMeter VCTE, NFSA, and TE were determined in 52 patients with NAFLD. The results of liver biopsies were considered the gold standard. Areas under the receiver operating characteristic curve were used to express the diagnostic accuracy of each test. RESULTS Significant (F≥2) and severe (F≥3) fibrosis were detected in 20 (38%) and 10 (19%) patients, respectively. The sensitivity of FibroMeter VCTE, NFSA, and TE for detecting significant fibrosis was 70, 65, and 75%, respectively, whereas specificity was 88, 81, and 78%. The sensitivity of FibroMeter VCTE, NFSA, and TE for diagnosing severe fibrosis was 90, 90, and 100%, respectively, whereas specificity was 93, 78, and 76%. Receiver operating characteristic analysis showed that FibroMeter VCTE had a significantly larger areas under the receiver operating characteristic curve (0.968) compared with both NFSA (0.833, P<0.001) and TE (0.922, P<0.05) for the detection of severe fibrosis. CONCLUSION Our preliminary findings indicate that FibroMeter VCTE is superior to both NFSA and TE for the diagnosis of severe fibrosis in patients with NAFLD.
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García-Monzón C, Vargas-Castrillón J, Porrero JL, Alonso MT, Bonachía O, Castillo MJ, Marcos A, Quirós E, Ramos B, Sánchez-Cabezudo C, Villar S, Sáez A, Rodríguez de Cía J, del Pozo E, Vega-Piris L, Soto-Fernández S, Lo Iacono O, Miquilena-Colina ME. Prevalence and risk factors for biopsy-proven non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in a prospective cohort of adult patients with gallstones. Liver Int 2015; 35:1983-91. [PMID: 25708133 DOI: 10.1111/liv.12813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Relationship between gallstones and non-alcoholic fatty liver disease (NAFLD), and largely non-alcoholic steatohepatitis (NASH), is uncertain. AIM To determine the prevalence, non-invasive fibrosis markers profile and risk factors for biopsy-proven NAFLD and NASH among patients with gallstones. METHODS Anthropometric and laboratory evaluation, an abdominal ultrasound and a liver biopsy were performed to 215 consecutive patients with gallstones referred for cholecystectomy. RESULTS Prevalence of NASH was 10.2% whereas that of simple steatosis (SS) was 41.4%. In the cohort of NAFLD patients, negative predictive values for advanced fibrosis of FIB-4 and NAFLD fibrosis score were 96 and 95% respectively. Gallstone patients with NASH had a higher mean homeostatic model assessment (HOMA) score than those with SS (P = 0.015). Noteworthy, NASH was 2.5-fold more frequent in patients with gallstones who had metabolic syndrome than in those who did not (P < 0.001). Fatty liver on ultrasound was observed in 90.9% of gallstone patients with NASH compared with 61.8% of those with SS (P = 0.044). Using multivariate logistic regression, increased HOMA score (OR, 3.47; 95% CI, 1.41-8.52; P = 0.007) and fatty liver on ultrasound (OR, 23.27; 95% CI, 4.15-130.55; P < 0.001) were the only factors independently associated with NASH. CONCLUSIONS Prevalence of NASH among patients with gallstones is lower than estimated previously, but NASH is frequent particularly in those patients with concurrent metabolic syndrome. The combination of an increased HOMA score with fatty liver on ultrasound has a good accuracy for predicting NASH in patients with gallstones.
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Affiliation(s)
- Carmelo García-Monzón
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain
| | - Javier Vargas-Castrillón
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.,Service of Pathology, Santa Cristina University Hospital, Madrid, Spain
| | - José Luís Porrero
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - María Teresa Alonso
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Oscar Bonachía
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - María José Castillo
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Alberto Marcos
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Esther Quirós
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Beatriz Ramos
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | | | - Sol Villar
- Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Alicia Sáez
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain
| | - Javier Rodríguez de Cía
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain
| | - Elvira del Pozo
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain
| | - Lorena Vega-Piris
- Statistics and Methodology Unit, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | | | - María Eugenia Miquilena-Colina
- Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain
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Kwak MS, Kim D, Chung GE, Kim W, Kim YJ, Yoon JH. Cholecystectomy is independently associated with nonalcoholic fatty liver disease in an Asian population. World J Gastroenterol 2015; 21:6287-6295. [PMID: 26034364 PMCID: PMC4445106 DOI: 10.3748/wjg.v21.i20.6287] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/09/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the relationship between gallstone disease and nonalcoholic fatty liver disease (NAFLD) in a large Asian population. METHODS A cross-sectional study including 17612 subjects recruited from general health check-ups at the Seoul National University Hospital, Healthcare System Gangnam Center between January 2010 and December 2010 was conducted. NAFLD and gallstone disease were diagnosed based on typical ultrasonographic findings. Subjects who were positive for hepatitis B or C, or who had a history of heavy alcohol consumption (> 30 g/d for men and > 20 g/d for women) or another type of hepatitis were excluded. Gallstone disease was defined as either the presence of gallstones or previous cholecystectomy, and these two entities (gallstones and cholecystectomy) were analyzed separately. Clinical parameters including body mass index, waist circumference, hypertension, diabetes, smoking status, and regular physical activity were reviewed. Laboratory parameters, including serum levels of gamma-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, fasting glucose, fasting insulin, total cholesterol, triglycerides, and high-density lipoprotein, were also reviewed. RESULTS The mean age of the subjects was 48.5 ± 11.3 years, and 49.3% were male. Approximately 30.3% and 6.1% of the subjects had NAFLD and gallstone disease, respectively. The prevalence of gallstone disease (8.3% vs 5.1%, P < 0.001), including both the presence of gallstones (5.5% vs 3.4%, P < 0.001) and a history of cholecystectomy (2.8% vs 1.7%, P < 0.001), was significantly increased in the NAFLD group. In the same manner, the prevalence of NAFLD increased with the presence of gallstone disease (41.3% vs 29.6%, P < 0.001). Multivariate regression analysis showed that cholecystectomy was associated with NAFLD (OR = 1.35, 95%CI: 1.03-1.77, P = 0.028). However, gallstones were not associated with NAFLD (OR = 1.15, 95%CI: 0.95-1.39, P = 0.153). The independent association between cholecystectomy and NAFLD was still significant after additional adjustment for insulin resistance (OR = 1.45, 95%CI: 1.01-2.08, P = 0.045). CONCLUSION This study shows that cholecystectomy, but not gallstones, is independently associated with NAFLD after adjustment for metabolic risk factors. These data suggest that cholecystectomy may be an independent risk factor for NAFLD.
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Subasi CF, Aykut UE, Yilmaz Y. Comparison of noninvasive scores for the detection of advanced fibrosis in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2015; 27:137-41. [PMID: 25486027 DOI: 10.1097/meg.0000000000000255] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The presence of advanced liver fibrosis portends a poor prognosis in nonalcoholic fatty liver disease (NAFLD). We aimed to compare the diagnostic performance of five noninvasive scores [aspartate aminotransferase/platelet ratio (APRI), BARD, FIB-4, NAFLD fibrosis score (NFSA), and FibroMeter] for the assessment of advanced stages of fibrosis (F ≥ 3) in patients with biopsy-proven NAFLD. METHODS APRI, BARD, FIB-4, NFSA, and FibroMeter scores were determined in 142 patients with NAFLD. The histopathological analysis of liver biopsies was considered the gold standard. Sensitivity and specificity were calculated for each noninvasive test using receiver operating characteristic (ROC) curve analysis, with a cut-off value of F ≥ 3 for advanced fibrosis. The diagnostic accuracies were assessed by measuring the area under the ROC curve (AUROC). The AUROCs for different noninvasive tests were compared using paired significance tests. RESULTS At histopathological examination, 40 patients (28.2%) had a fibrosis stage F0, 50 patients (35.2%) had F1, 22 patients (15.5%) had F2, 20 patients (14.1%) had F3, and 10 patients (7.0%) had F4. The sensitivity of APRI, BARD, FIB-4, NFSA, and FibroMeter scores for advanced fibrosis was 70.0, 73.3, 70.0, 66.7, and 66.7%, respectively, and the specificity was 74.5, 66.4, 71.8, 71.8, and 74.5%, respectively. No significant differences in terms of sensitivity and specificity were evident for the five noninvasive scores. Moreover, the AUROCs did not differ significantly for all scores. CONCLUSION Our study suggests that different noninvasive scores have similar accuracy for the diagnosis of advanced hepatic fibrosis in NAFLD.
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Affiliation(s)
- Cemal F Subasi
- aDepartment of Internal Medicine, School of Medicine bInstitute of Gastroenterology cDepartment of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
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