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Cholecystectomy may be risk factor for NAFLD

Nonalcoholic fatty liver disease is associated with having undergone cholecystectomy, but not with the presence of gallstones, according to recent results.

Researchers evaluated ultrasonography results in 12,232 adult participants enrolled in the National Health and Nutrition Examination Survey between 1988 and 1994 (NHANES III). No participants had viral hepatitis or reported significant alcohol intake.

Nonalcoholic fatty liver disease (NAFLD) was observed in 20% of the cohort, while 7.4% had gallstones and 5.6% had previously undergone cholecystectomy. NAFLD incidence was significantly greater among cholecystectomy recipients (48.4%) than in nonrecipients with (34.4%) or without gallstones (17.9%), after adjusting for age and sex (P<.01 for all comparisons).

Multivariate analysis indicated a significant association between NAFLD and cholecystectomy (OR=2.43; 95% CI, 1.81-3.28), while no association was observed between NAFLD and gallstones (OR=1.09; 95% CI, 0.84-1.42). Sex-specific analysis showed a stronger association among men (OR=4.07; 95% CI, 2.63-6.3 vs. OR=2.11; 95% CI, 1.50-2.97 for women). Further adjustment for the presence of right upper quadrant or epigastric pain indicated a stronger association between NAFLD and gallstone disease among recipients without pain (OR=3.02; 95% CI, 2.19-4.18) than those with pain (OR=1.66; 95% CI, 0.98-2.81).

In an additional analysis limited to 985 patients who reported moderate alcohol consumption (more than two drinks per day for males or more than one for females), no association was observed between steatosis and gallstone disease (OR=1.01; 95% CI, 0.31-3.27), but a relationship between cholecystectomy and steatosis trended toward significance (OR=2.59; 95% CI, 0.44-15.21).

“In the US population, NAFLD is common among persons with gallstone disease, but the relationship is confined to persons who had cholecystectomy rather than persons with ultrasound-diagnosed gallstones,” the researchers wrote. “Therefore, cholecystectomy might be considered a risk factor for NAFLD. Because cholecystectomy is so commonly performed and its long-term medical consequences are believed to be uncommon, it is important that the findings of this study be confirmed or rejected.”