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©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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research 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 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.
Research results
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).
Research conclusions
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.
Research perspectives
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.
