title: Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.
authors: Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca' Granda Foundation, Milano, Italy.
authors: Anna Ludovica
authors: AL
authors: Fracanzani
authors: Luca
authors: L
authors: Valenti
authors: Maurizio
authors: M
authors: Russello
authors: Luca
authors: L
authors: Miele
authors: Cristina
authors: C
authors: Bertelli
authors: Alessandro
authors: A
authors: Bellia
authors: Chiara
authors: C
authors: Masetti
authors: Consuelo
authors: C
authors: Cefalo
authors: Antonio
authors: A
authors: Grieco
authors: Giulio
authors: G
authors: Marchesini
authors: Silvia
authors: S
authors: Fargion
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000818:Animals; D048909:Diabetes Complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D056128:Obesity, Abdominal / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D005947:Glucose