Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease

Anna Ludovica Fracanzani, Luca Valenti, Maurizio Russello, Luca Miele, Cristina Bertelli, Alessandro Bellia, Chiara Masetti, Consuelo Cefalo, Antonio Grieco, Giulio Marchesini, Silvia Fargion

Research output: Contribution to journalArticle

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease. Methodology/Principal Findings: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20%), and 313 cases (60%) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95% CI 1.04-1.8), age (OR 1.027, 95% CI1.003-1.05), fasting glucose (OR 1.21, 95% CI 1.10-1.33) and NASH (OR 1.40,95% CI 1.06-1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95% CI 0.97-0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained. Conclusion: Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.

Original languageEnglish
Article numbere41183
JournalPLoS One
Volume7
Issue number7
DOIs
Publication statusPublished - Jul 25 2012

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cholelithiasis
fatty liver
Gallstones
Liver
liver
fasting
Glucose
Fasting
glucose
liver diseases
diabetes
Liver Diseases
biopsy
obesity
Fibrosis
Non-alcoholic Fatty Liver Disease
Biopsy
Prediabetic State
Medical problems
gender

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease. / Fracanzani, Anna Ludovica; Valenti, Luca; Russello, Maurizio; Miele, Luca; Bertelli, Cristina; Bellia, Alessandro; Masetti, Chiara; Cefalo, Consuelo; Grieco, Antonio; Marchesini, Giulio; Fargion, Silvia.

In: PLoS One, Vol. 7, No. 7, e41183, 25.07.2012.

Research output: Contribution to journalArticle

Fracanzani, Anna Ludovica ; Valenti, Luca ; Russello, Maurizio ; Miele, Luca ; Bertelli, Cristina ; Bellia, Alessandro ; Masetti, Chiara ; Cefalo, Consuelo ; Grieco, Antonio ; Marchesini, Giulio ; Fargion, Silvia. / Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease. In: PLoS One. 2012 ; Vol. 7, No. 7.
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abstract = "Background: Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease. Methodology/Principal Findings: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20{\%}), and 313 cases (60{\%}) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95{\%} CI 1.04-1.8), age (OR 1.027, 95{\%} CI1.003-1.05), fasting glucose (OR 1.21, 95{\%} CI 1.10-1.33) and NASH (OR 1.40,95{\%} CI 1.06-1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95{\%} CI 0.97-0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained. Conclusion: Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.",
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T1 - Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease

AU - Fracanzani, Anna Ludovica

AU - Valenti, Luca

AU - Russello, Maurizio

AU - Miele, Luca

AU - Bertelli, Cristina

AU - Bellia, Alessandro

AU - Masetti, Chiara

AU - Cefalo, Consuelo

AU - Grieco, Antonio

AU - Marchesini, Giulio

AU - Fargion, Silvia

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N2 - Background: Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease. Methodology/Principal Findings: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20%), and 313 cases (60%) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95% CI 1.04-1.8), age (OR 1.027, 95% CI1.003-1.05), fasting glucose (OR 1.21, 95% CI 1.10-1.33) and NASH (OR 1.40,95% CI 1.06-1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95% CI 0.97-0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained. Conclusion: Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.

AB - Background: Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease. Methodology/Principal Findings: We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20%), and 313 cases (60%) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95% CI 1.04-1.8), age (OR 1.027, 95% CI1.003-1.05), fasting glucose (OR 1.21, 95% CI 1.10-1.33) and NASH (OR 1.40,95% CI 1.06-1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95% CI 0.97-0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained. Conclusion: Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.

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