title: Interval increase in the prevalence of symptomatic cholelithiasis-associated non-alcoholic fatty liver disease over a ten-year period in an Asian population.
abstract: Non-alcoholic fatty liver disease (NAFLD) is frequently associated with cholelithiasis. The prevalence of NAFLD in Asia has been on the rise, but the magnitude of this increase had not been studied previously.
  
  
  
  A retrospective cohort study was conducted on consecutive patients who underwent laparoscopic or open cholecystectomy from November 2001 to November 2004 (Cohort 1) and from November 2011 to November 2014 (Cohort 2) at Singapore General Hospital. Preoperative diagnostic scans (e.g. ultrasonography, computed tomography and magnetic resonance imaging) and clinical data were reviewed for the presence of fatty liver. Statistical analysis was performed.
  
  
  
  In Cohorts 1 and 2, 127 patients and 99 patients were operated on, respectively. Cohort 2 had significantly higher proportions of patients with NAFLD (56.6% vs. 40.2%; p < 0.015) and hyperlipidaemia (45.5% vs. 18.9%; p < 0.001) as compared to Cohort 1. Binary logistic regression analysis showed that hypertension (odds ratio [OR] 2.558; p < 0.004) and Indian ethnicity (OR 5.448; p < 0.043) were significantly associated with NAFLD.
  
  
  
  Similar to other international studies, we found a significant increase in the prevalence of patients with NAFLD presenting symptomatically for cholecystectomy over an interval of ten years in Singapore. Hypertension and Indian ethnicity were significantly associated with NAFLD in both time periods. This trend supports the need for concerted public health intervention to stem the increasing incidence of NAFLD and prevent its progression to more advanced liver disease.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore.
authors.forename: Kevin Beng Chin
authors.initials: KB
authors.lastname: Khaw
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore.
authors.forename: Rachel Huiyi
authors.initials: RH
authors.lastname: Choi
authors.affiliation: Department of Hepatopancreatobiliary/Transplant Surgery, Singapore General Hospital, Singapore.
authors.forename: Juinn Huar
authors.initials: JH
authors.lastname: Kam
authors.affiliation: Office of Clinical Sciences, Duke-NUS Medical School, Singapore.
authors.forename: Bibhas
authors.initials: B
authors.lastname: Chakraborty
authors.affiliation: Department of Hepatopancreatobiliary/Transplant Surgery, Singapore General Hospital, Singapore.|Office of Clinical Sciences, Duke-NUS Medical School, Singapore.|Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Pierce Kah Hoe
authors.initials: PK
authors.lastname: Chow
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India; D008099:Liver; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Asian; Singapore; cholelithiasis; epidemiology; non-alcoholic fatty liver disease