Gallstone disease and nonalcoholic fatty liver disease in patients with type 2 diabetes: a cross-sectional study

Ye Lu; Lili Hu; Jing Song; Jing Wan; Haibing Chen; Jun Yin

doi:10.1186/s12902-021-00899-z

Gallstone disease and nonalcoholic fatty liver disease in patients with type 2 diabetes: a cross-sectional study

BMC Endocr Disord. 2021 Nov 19;21(1):231. doi: 10.1186/s12902-021-00899-z.

Authors

Ye Lu¹, Lili Hu², Jing Song¹, Jing Wan¹, Haibing Chen³, Jun Yin^{4

5}

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China.
² 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.
³ Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, Shanghai, 200072, China. hbchen8@163.com.
⁴ Department of Endocrinology and Metabolism, Shanghai Eighth People's Hospital, Shanghai, 200235, China. yinjun@sjtu.edu.cn.
⁵ 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. yinjun@sjtu.edu.cn.

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.

Keywords: Cholecystectomy; Gallstone disease; Nonalcoholic fatty liver disease; Type 2 diabetes mellitus.

MeSH terms

Aged
Body Mass Index
Case-Control Studies
Cholecystectomy
Comorbidity
Cross-Sectional Studies
Diabetes Mellitus, Type 2 / epidemiology*
Female
Gallstones / diagnosis
Gallstones / epidemiology*
Humans
Male
Middle Aged
Non-alcoholic Fatty Liver Disease / diagnosis
Non-alcoholic Fatty Liver Disease / epidemiology*
Retrospective Studies
Ultrasonography