Frequency of Gallstones in Patients With Non-alcoholic Fatty Liver Disease

TL;DR

This study finds that about 22% of non-alcoholic fatty liver disease patients in Pakistan also have gallstones, with risk factors including age, being female, and high triglycerides.

Contribution

The study reports the frequency of gallstones in NAFLD patients in Pakistan and identifies associated risk factors.

Findings

Gallstones were present in 22.4% of NAFLD patients.

Female gender, older age, elevated triglycerides, and increased GGT levels were significantly associated with gallstones.

Abstract

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a metabolically related liver disease that is becoming increasingly prevalent globally, due to rising obesity, diabetes, and sedentary lifestyles. Concurrently, gallstone disease is a prevalent biliary disease and shares similar risk factors to NAFLD, such as dyslipidemia, insulin resistance, and obesity. In Pakistan, due to a paradigm shift toward urbanization and sedentary lifestyles in recent times, the data are scarce regarding the coexistence of gallstones in the NAFLD population. Therefore, we aimed to find the frequency of gallstones among the NAFLD population and compare the clinical, biochemical, and metabolic profiles of cases of NAFLD presenting with and without gallstones.

Study methodology

A cross-sectional observational study was carried out at the Department of Hepatogastroenterology and General Surgery, Sindh Institute of Urology and Transplantation, Karachi, from January 1, 2023, to June 30, 2023. There were 246 adult patients (age 18 years or above) diagnosed with NAFLD by ultrasound. Those patients having significant alcohol use, pre-existing liver illness, previous cholecystectomy, pregnancy, or drugs that alter the lipid profile were excluded. Clinical, demographic, and laboratory data were recorded, and a fasting abdominal ultrasound was carried out to diagnose NAFLD and identify gallstones. SPSS version 26.0 (IBM Corp., Armonk, NY) was used for data analysis, and a p-value of less than 0.05 was considered statistically significant.

Results

Among 246 patients with NAFLD, 152 (62%) were women. The mean age was 48.3 ± 10.2 years. Gallstones were diagnosed in 55 (22.4%) of the patients. Advanced age (p = 0.013), female gender (p = 0.037), increased gamma-glutamyl transpeptidase (GGT) levels (p = 0.029), and increased triglyceride levels (p ≤ 0.01) were significantly associated with gallstones.

Conclusion

This study points toward a high co-occurrence of gallstone disease in NAFLD patients, which is 22.4%. Major risk factors were female gender, old age, hypertriglyceridemia, and increased GGT levels. Timely detection and specific screening for gallstones in patients with NAFLD may reduce biliary complications and also lead to better clinical outcomes. It is advisable to conduct multicenter prospective studies for the generalizability of the findings of this study.