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Hypertension, BMI, Indian ethnicity tied to cholelithiasis-associated NAFLD

Stephen Padilla
26 Dec 2017

There has been a substantial rise in the number of patients with symptomatic cholelithiasis-associated nonalcoholic fatty liver disease (NAFLD), as well as hyperlipidaemia, over the span of 10 years, according to a recent study.

“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 10 years in Singapore,” researchers said.

Moreover, hypertension and Indian ethnicity are significantly associated with NAFLD in both time periods of the study: November 2001 to November 2004 (cohort 1) and November 2011 to November 2014 (cohort 2). This finding supports the need for public health intervention to reduce the rising incidence of NAFLD and prevent its progression to more advanced liver disease, researchers noted.

Laparoscopic or open cholecystectomy was performed on 127 patients in cohort 1 and 99 patients in cohort 2. The second group had significantly greater proportions of patients with NAFLD (56.6 vs 40.2 percent; p<0.015) and hyperlipidaemia (45.5 vs 18.9 percent; p<0.001) as compared to the first one. [Singapore Med J 2017;58:703-707]

Binary logistic regression analysis revealed that hypertension (odds ratio [OR], 2.558; p<0.001) and Indian ethnicity (OR, 5.448; p<0.043) significantly correlated with NAFLD.

“Over the 10-year interval, there was a significant increase in both NAFLD and hyperlipidaemia in patients who underwent cholecystectomy at our centre,” researchers said. “NAFLD was significantly associated with hypertension, BMI (body mass index), and Indian ethnicity.”

This study also supports established literature showing the independent association of arterial hypertension, a manifestation of metabolic syndrome, with NAFLD. Furthermore, previous studies have shown at least a twofold prevalence of NAFLD in nonobese and nondiabetic hypertensive patients compared with the general population. [Gut 2004;53:1020-1023]

“Our results indicate that hypertension, in addition to BMI, needs to be better controlled in our local population,” researchers noted.

The study also showed that Indian patients were at greater risk for NAFLD compared with Chinese patients, but this finding should be viewed in light of the small sample of Indian patients (n=10).

“However, this result is in line with regional studies showing that patients of Indian ethnicity are more predisposed to NAFLD than Chinese patients, ostensibly due to the higher prevalence of obesity in the former group,” researchers said. [Hepatol Int 2013;7:548-554; Hepatol Int 2014;8:121-127]

“Interestingly, it was previously shown that Asian Indians have a higher body fat percentage and abdominal adiposity even when BMI is within normal limits,” they added. [Nutrition 2004;20:482-491]

These findings pave the way for confirmatory studies that will help establish the characteristics of individuals who are likely to be at risk and identify at-risk patients for future prospective trials, according to researchers.

This retrospective cohort study was conducted on consecutive patients who underwent laparoscopic or open cholecystectomy at Singapore General Hospital. Researchers reviewed preoperative diagnostic scans (eg, ultrasonography, computed tomography, and magnetic resonance imaging) and clinical data for the presence of fatty liver, as well as performed statistical analysis.

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