Association of Non-alcoholic Fatty Liver Disease with Symptomatic and Asymptomatic Cholelithiasis: Cohort from Southeast Asian Patients

Introduction: With increasing prevalence of metabolic syndrome, sedentary lifestyle, and diabetes mellitus the burden of non-alcoholic fatty liver disease (NAFLD) is also increasing along with its complications including gallstone disease. That is why, this study aims to determine the association between non-alcoholic fatty liver disease with the prevalence of gallstone disease and also, risk factors associated with symptomatic and asymptomatic cholelithiasis.

Methods: A prospective study design was performed and during the data collection phase we have enrolled a total of 218 patients who were diagnosed as a case of NAFLD from Asian Institute of Medical Sciences, Hyderabad between the periods of 19 months from March 2019 to October 2020. Diagnosis of NAFLD was made using liver biopsy and cholelithiasis with ultrasound abdomen. Both males and females with a primary diagnosis of NAFLD were included in this study. Patients were divided into symptomatic and asymptomatic gallstone disease and were further assessed for underlying risk factor associated with symptomatic and asymptomatic gallstone disease. Statistical package for the social sciences version 21 (SPSS) used for the entry of data and final analysis and a p value of <0.05 were considered as statistically significant.

Results: The overall prevalence of gallstone disease in patients with NAFLD was 12.84% (n = 28) among them 19 (67.85%) patients were having symptomatic gallstone disease while 9 patients had asymptomatic gallstones disease (32.14%). Patients having mean age 49.01 years, uncontrolled blood sugar level (209.24 mg/dl), mean alkaline phosphatase 106.22 IU/L, female gender, and having diabetes mellitus were significantly associated with symptomatic gallstones disease (p value <0.05).

Conclusion: In our study, the cohorts have shown bidirectional association between gallstone disease and NAFLD. Also prevalence of symptomatic gallstone disease is quite high and it was strongly associated with increasing age, female gender, raised blood glucose levels, and diabetes mellitus.