Bidirectional association between NAFLD and gallstone disease: a systematic review and meta-analysis of observational studies

Growing evidence indicates an association between NAFLD and gallstone disease (GD), while some does not support this. The aim of this meta-analysis was to evaluate the bidirectional association between NAFLD and GD. Five electronic databases were searched from inception to May 2022. The association was analyzed based on the odds ratio (OR) and 95% confidence interval (CI) with Reviewer Manager 5.3. Ten studies involving 284,512 participants met the criteria for GD predicting the onset of NAFLD. GD patients had a higher incidence of NAFLD (OR:1.48, CI:1.32–1.65, p < 0.00001), especially the incidence of moderate-to-severe NAFLD (OR:1.63; CI:1.40–1.79), with females at a higher risk (OR: 1.84; CI: 1.48–2.29). The inverse association was explored in eight studies involving 326,922 participants. The GD incidence in NAFLD patients was higher (OR:1.71, CI:1.63–1.79, p < 0.00001) and may increase due to female sex (OR: 4.18; CI: 1.21–14.37) and high BMI (OR: 1.80; CI: 1.36–2.56), compared with the non-NAFLD group. Besides, this bidirectional association was also confirmed in the Chinese population. The findings supported positive concurrent and bidirectional relationships between NAFLD and GD. Therefore, clinicians may alert the possibility of NAFLD in patients with GD and vice versa.

越来越多的证据表明非酒精性脂肪性肝病（Non-Alcoholic Fatty Liver Disease, NAFLD）与胆石症（Gallstone Disease, GD）之间存在关联，但也有部分研究并不支持这一结论。本项荟萃分析旨在评估NAFLD与GD之间的双向关联。本研究检索了截至2022年5月的五个电子数据库，采用Review Manager 5.3软件，基于比值比（Odds Ratio, OR）与95%置信区间（Confidence Interval, CI）对二者的关联进行分析。针对GD预测NAFLD发病的相关研究，共有10项符合纳入标准，涉及284512名受试者。结果显示，胆石症患者的NAFLD发病率更高（OR=1.48，95%CI=1.32~1.65，p<0.00001），其中中重度NAFLD的发病风险升高更为显著（OR=1.63，CI=1.40~1.79），且女性群体的发病风险更高（OR=1.84，CI=1.48~2.29）。针对NAFLD预测GD发病的反向关联研究，共有8项符合纳入标准，涉及326922名受试者。与非NAFLD群体相比，非酒精性脂肪性肝病患者的胆石症发病率更高（OR=1.71，CI=1.63~1.79，p<0.00001），且女性（OR=4.18，CI=1.21~14.37）与高体重指数（Body Mass Index, BMI）人群（OR=1.80，CI=1.36~2.56）的发病风险进一步升高。此外，该双向关联在中国人群中也得到了验证。本研究结果证实NAFLD与GD之间存在正向且双向的关联。因此，临床医师需警惕胆石症患者合并NAFLD的可能，反之亦然。