Gall stones in non-alcoholic fatty liver disease and its relation to insulin resistance and apolipoprotein-B

Data suggest that hyperinsulinemia is a risk factor for both gall stones and non-alcoholic fatty liver disease [NAFLD]. Was to evaluate the relation of insulin resistance and serum Apolipoprotein-B with gall stone disease [GD] in patients with non-alcoholic fatty liver disease [NAFLD]. A total of 60 patients with NAFLD were included in the study and diagnosed with ultrasonography in the absence of known aetiologies of liver diseases. They were classified into two groups; 40 patients with gall stones and 20 without gall stones. Insulin resistance, BMI and biochemical markers were compared. Insulin resistance [HOMA-IR >2] was found in 16 patients of group I and 6 patients in group II. On comparing both study groups, the difference was statistically non-significant [1.99 +/- 1.07 Vs 1.64 +/- 1.16, p >0.05]. S. uric acid was significantly higher in group I than group II [6.71 +/- 1.91 vs. 5.33 +/- 1.57, P <0.05]. Also, S. uric acid was higher in male patients of group I than males in group II [7.77 +/- 1.63 vs. 5.96 +/- 0.34, P <0.05]. In our study, fasting insulin was higher in females of group I than females in group II [7.55 +/- 3.74 vs. 3.84 +/- 0.88, P <0.05]. It was found that there was no statistically significant association between serum Apolipoprotein-B and HOMA-IR in the overall series [1.58+7-171.17 in HOMA-IR<2 Vs 134.77+7-46.06 in HOMA-IR>2, p >0.05] and in each of the study groups. At stepwise regression analysis, it was found that serum uric acid was associated with gall stone disease in the overall series and in men. Also stepwise regression analysis indicated that fasting insulin, s. uric acid, fasting glucose, fasting triglycerides and BMI were important factors associated with gall stone disease in all our study's female patients. The association of HOMA-IR with gall stones disease in NAFLD is controversial as no statistically significant difference was found regarding HOMA-IR on comparing NAFLD patients with to those without gall stones. S. uric acid is a risk factor and associated with gall stone disease in men with NAFLD. Fasting serum insulin, serum triglycerides and BMI are important risk factors associated with gall stone disease in women with NAFLD