title: Prevalence and risk factors for biopsy-proven non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in a prospective cohort of adult patients with gallstones.
abstract: OBJECTIVE
  Relationship between gallstones and non-alcoholic fatty liver disease (NAFLD), and largely non-alcoholic steatohepatitis (NASH), is uncertain.
  
  
  OBJECTIVE
  To determine the prevalence, non-invasive fibrosis markers profile and risk factors for biopsy-proven NAFLD and NASH among patients with gallstones.
  
  
  METHODS
  Anthropometric and laboratory evaluation, an abdominal ultrasound and a liver biopsy were performed to 215 consecutive patients with gallstones referred for cholecystectomy.
  
  
  RESULTS
  Prevalence of NASH was 10.2% whereas that of simple steatosis (SS) was 41.4%. In the cohort of NAFLD patients, negative predictive values for advanced fibrosis of FIB-4 and NAFLD fibrosis score were 96 and 95% respectively. Gallstone patients with NASH had a higher mean homeostatic model assessment (HOMA) score than those with SS (P = 0.015). Noteworthy, NASH was 2.5-fold more frequent in patients with gallstones who had metabolic syndrome than in those who did not (P < 0.001). Fatty liver on ultrasound was observed in 90.9% of gallstone patients with NASH compared with 61.8% of those with SS (P = 0.044). Using multivariate logistic regression, increased HOMA score (OR, 3.47; 95% CI, 1.41-8.52; P = 0.007) and fatty liver on ultrasound (OR, 23.27; 95% CI, 4.15-130.55; P < 0.001) were the only factors independently associated with NASH.
  
  
  CONCLUSIONS
  Prevalence of NASH among patients with gallstones is lower than estimated previously, but NASH is frequent particularly in those patients with concurrent metabolic syndrome. The combination of an increased HOMA score with fatty liver on ultrasound has a good accuracy for predicting NASH in patients with gallstones.
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.
authors.forename: Carmelo
authors.initials: C
authors.lastname: García-Monzón
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.|Service of Pathology, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vargas-Castrillón
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Porrero
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Alonso
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Bonachía
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Castillo
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marcos
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Quirós
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ramos
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez-Cabezudo
authors.affiliation: Service of General and Abdominal Surgery, Santa Cristina University Hospital, Madrid, Spain.
authors.forename: Sol
authors.initials: S
authors.lastname: Villar
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Sáez
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodríguez de Cía
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.
authors.forename: Elvira
authors.initials: E
authors.lastname: del Pozo
authors.affiliation: Statistics and Methodology Unit, Instituto de Investigación Sanitaria Princesa, Madrid, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Vega-Piris
authors.affiliation: Gastroenterology Unit, Hospital del Tajo, Aranjuez, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Soto-Fernández
authors.affiliation: Gastroenterology Unit, Hospital del Tajo, Aranjuez, Spain.
authors.forename: Oreste
authors.initials: O
authors.lastname: Lo Iacono
authors.affiliation: Liver Research Unit, Santa Cristina University Hospital, Instituto de Investigación Sanitaria Princesa, CIBERehd, Madrid, Spain.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Miquilena-Colina
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D017081:Cholecystectomy, Laparoscopic; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: epidemiology; gallstones; liver biopsy; metabolic syndrome; non-alcoholic steatohepatitis; non-invasive fibrosis markers