Association Between Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome with Gallstone Disease, South Iran: A Population-Based Study

Figures & data

Table 1 Two Criteria for Clinical Diagnosis of Metabolic Syndrome (MetS) Which were Used in This Study

Measures	MetS Criteria
	NCEP/ATP-III	CCDMIA
Waist circumference	>102 and >88 cm in men and women	≥95 cm in both genders
Triglyceride	≥150 mg/dL	≥150 mg/dL
High density lipoprotein	<40 and <50 mg/dL in men and women	<40 and <50 mg/dL in men and women
Blood pressure	SBP/DBP ≥130/85 mmHg	SBP/DBP ≥130/85 mmHg
Fasting blood sugar	≥110 mg/dL	≥100 mg/dL

Abbreviations: NCEP/ATP-III, National Cholesterol Education Program Adult Treatment Panel III; CCDMIA, Criteria for Clinical Diagnosis of MetS in Iranian Adults; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Figure 1 Flow diagram for the participants’ selection process.

Notes: ^aParticipants with history of cholecystectomy, pregnancy, alcoholism, viral hepatitis, auto immune hepatitis, Hemochromatosis, Wilson disease, medication use that causes hepatic steatosis (eg, anti-retroviral agents for HIV, amiodarone, methotrexate, glucocorticoids, valproate, and tamoxifen), known cases of malignancy, drug-induced liver injury, cirrhosis, and non-cooperative patients were excluded.

Abbreviations: K.C.S, Kavar Cohort Study; MetS, metabolic syndrome; NCEP/ATP-III, National Cholesterol Education Program Adult Treatment Panel III; CCDMIA, Criteria for Clinical Diagnosis of MetS in Iranian Adults; NAFLD, non-alcoholic fatty liver disease.

Table 2 Baseline Demographic and Clinical Characteristics of Enrolled Gallstone Disease (GSD) (n=59) and Non- GSD Participants (N= 177)

Variables	GSD Group; N (%)	Non-GSD Group; N (%)	P-value
Gender^a			0.158
Female	51 (86.4%)	138 (78.0%)
Male	8 (13.6%)	39 (22.0%)
Age^b (years)	49.78 (16.15%)	51.53 (17.11%)	0.494
Body mass index^c (kg/m^2)	26.68 (4.77%)	25.17 (4.57%)	0.022
Education^a			0.708
Elementary	49 (83.0%)	146 (82.4%)
High school	2 (3.4%)	2 (1.1%)
Diploma	6 (10.2%)	16 (9.0%)
Bachelor	2 (3.4%)	13 (7.3%)
NCEP/ATP-III criteria^a	20 (33.9%)	58 (32.8%)	0.873
CCDMIA criteria^a	23 (39.0%)	59 (33.3%)	0.430
NAFLD^a	25 (42.4%)	40 (22.6%)	0.003

Notes:t ^aChi-square Test. ^bMean (standard deviation); t-test. ^cMean (standard deviation); Mann–Whitney test

Abbreviations: NCEP/ATP-III, National Cholesterol Education Program Adult Treatment Panel III; CCDMIA, Criteria for Clinical Diagnosis of MetS in Iranian Adults; NAFLD, non-alcoholic fatty liver disease.

Table 3 The Comparison of Metabolic Syndrome (MetS) Components Between Gallstone Disease (GSD) and Non- GSD Groups

MetS Components	Groups	Mean ± Standard Deviation	P-value*
Waist circumference (cm)	GSD	91.14 ± 13.48	0.041
	Non-GSD	87.24 ± 12.36
Systolic blood pressure (mmHg)	GSD	120.59 ± 21.62	0.976
	Non-GSD	120.48 ± 25.52
Diastolic blood pressure (mmHg)	GSD	77.03 ± 12.53	0.102
	Non-GSD	74.04 ± 12.01
High density lipoprotein (mg/dL)	GSD	44.50 ± 10.69	0.152
	Non-GSD	47.20 ± 11.78
Triglycerides (mg/dL)	GSD	137.22 ± 103.81	0.451
	Non-GSD	124.18 ± 107.91
Fasting blood sugar (mg/dL)	GSD	98.88 ± 27.91	0.528
	Non-GSD	96.24 ± 25.25

Note: *t-test.

Table 4 The Comparison Between Each Component of Metabolic Syndrome (MetS) and Presence of Gallstone Disease (GSD), Based on NCEP/ATP-III^a and CCDMIA^b Criteria

MetS Components; N (%)	Picture	Groups		P-value*
		GSD (59)	Non-GSD (177)
High Waist Circumference
NCEP/ATPIII	Yes	35 (32.7)	72 (67.3)	0.013
	No	24 (18.6)	105 (81.4)
CCDMIA	Yes	25 (34.7)	47 (65.3)	0.022
	No	34 (20.7)	130 (79.3)
Hyperglycemia
NCEP/ATPIII	Yes	13 (31.0%)	29 (69.0%)	0.326
	No	46 (23.7%)	148 (76.3%)
CCDMIA	Yes	23 (30.7%)	52 (69.3%)	0.170
	No	36 (22.4%)	125 (77.6%)
Hypertension	Yes	29 (28.4)	73 (71.6)	0.288
	No	30 (22.4)	104 (77.6)
Low HDL level	Yes	44 (27.8%)	114 (72.2%)	0.150
	No	15 (19.2%)	63 (80.8%)
Hypertriglyceridemia	Yes	20 (26.7%)	55 (73.3%)	0.687
	No	39 (24.2%)	122 (79.2)

Notes: ^aNational Cholesterol Education Program Adult Treatment Panel III. ^bCriteria for Clinical Diagnosis of MetS in Iranian Adults. *Chi-square Test.

Table 5 The Comparison of Clinical and Demographic and Laboratory Data Characteristics Between Non-Alcoholic Fatty Liver Disease (NAFLD) (n=65) and Non-NAFLD (n=171) Groups

Variables	NAFLD	Non-NAFLD	P-value
Gender; N (% within NAFLD)^a  Female  Male	56 (86.2%) 9 (13.8%)	133 (77.8%) 38 (22.2%)	0.150
Age^b(years)	57.11 (10.60)	48.79 (18.22)	<0.001
Body mass index^b (kg/m^2)	28.80 (3.902)	24.31 (4.31)	<0.001
Waist circumference^b, cm	96.94 (11.56)	84.90 (11.56)	<0.001
Fasting blood sugar^c; mg/dL	101.45 (24.47)	95.14 (26.15)	0.005
Aspartate transaminase^c; IU/L	28.15 (21.92)	17.08 (8.20)	<0.001
Alanine transaminase^c; IU/L	26.88 (24.91)	12.44 (6.86)	<0.001
Alkaline phosphatase^c; IU/L	198.85 (62.00)	184.78 (72.99)	0.052
Total cholesterol^c; mg/dL	190.78 (44.85)	157.05 (46.20)	<0.001
Triglyceride^c; mg/dL	176.30 (155.58)	109.19 (75.74)	<0.001
HDL-cholesterol ^c; mg/dL	45.71 (11.51)	46.96 (11.63)	0.474
Blood pressure
Systolic blood pressure^c; mm Hg	128.00 (25.63)	117.66 (23.59)	0.004
Diastolic blood pressure^c; mm Hg	79.69 (11.31)	72.92 (12.01)	<0.001

Notes: ^aChi-square Test. ^bMean (standard deviation); t-test. ^cMean (standard deviation); Mann–Whitney test.

Table 6 The Comparison of Liver Biochemical Tests and Different Types of Non-Alcoholic Fatty Liver Disease (NAFLD) Between Gallstone Disease (GSD) (n=59) and Non- GSD (n=177) Groups

Laboratory Data Variables*	GSD	Non-GSD	P-value
NAFLD*^a; N (% within GSD)	25 (42.4%)	40 (22.6%)	0.003
Grade 1	17 (28.8%)	24 (13.6%)	0.008
Grade 2	6 (10.2%)	15 (8.5%)	0.692
Grade 3	2 (3.4%)	1 (0.6%)	0.100
Alanine transaminase^b; IU/L	14.78 (9.26)	16.97 (17.24)	0.148
Aspartate transaminase^b; IU/L	18.02 (8.46)	20.83 (15.71)	0.742
Alkaline phosphatase^b; IU/L	202.17 (103.87)	184.15 (54.41)	0.398
Body mass index^c (kg/m^2)	26.68 (4.77)	25.17 (4.57)	0.031

Notes: ^aChi-square test. ^bMean (standard deviation); Mann–Whitney test. ^cMean (standard deviation); t-test. *The severity of NAFLD on sonography was divided as follows: grade 1, slight and diffuse increase in echoes of liver parenchyma with normal visualization of intrahepatic vessel borders and diaphragm; grade 2, moderate and diffuse increase in echoes of liver parenchyma with slightly impaired visualization of diaphragm and intrahepatic vessels; grade 3, marked increase in echoes of liver parenchyma with poor or non-visualization of intrahepatic vessel borders, diaphragm, and posterior right lobe of the liver.