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

ABSTRACT

Background

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.

Research design and methods

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.

Results

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.

Conclusions

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.

KEYWORDS:

• NAFLD
• gallstone disease
• meta-analysis
• incidence
• bidirectional association

Article highlights

• Gallstone disease may be a relevant risk factor for the high incidence of NAFLD

• NAFLD can also promote incidence of gallstone disease

• This bidirectional relationship appears to be affected by Sex, BMI and NAFLD grade distributions

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties. And all authors declare that they have no conflict of interest.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions statement

GR Fan provided overall supervision of this meta-analysis and resolved disagreements. SY Gu and SS Hu conducted the literature search, data extraction, study quality assessment and drafting of the manuscript. SW Wang and CD Qi contributed to analysis and interpretation of data. CY Shi revised the manuscript. All authors have made a significant contribution to this manuscript and accept the responsibility for the study protocol and the presented results. All authors have read and approved the final version of the manuscript and consent to its publication.

Availability of data and materials

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2023.2175671

Additional information

Funding

This study was supported by grants from National Natural Science Foundation of China [No. 81973289].