Effect of cholecystectomy on hepatic fat accumulation and insulin resistance in non-obese Hispanic patients: a pilot study

Abstract

BackgroundNonalcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. Experimental studies have shown that cholecystectomy (XGB) increases hepatic fat content in mice and appears associated to NAFLD in large retrospective population-based studies. The aim of this study was to prospectively assess the effects of XGB on hepatic fat content (HFC) and insulin resistance (IR) in non-obese, middle aged Hispanic subjects.MethodsTwenty-six gallstone patients undergoing elective XGB and 16 control subjects with normal livers and gallbladders at ultrasonography were prospectively followed 24 months for changes in HFC and IR. Clinical, biochemical determinations and hepatic imaging were performed at baseline and 24 months after surgery. MRI technique quantified HFC in four hepatic segments. IR was assessed by the Homeostasis Model Assessment (HOMA-IR) index.ResultsInitial body mass index (BMI) was 25.6 ± 0.4 and 24.3 ± 1.0 in the control and XGB groups of subjects, respectively. Serum insulin level increased from 8.1 ± 0.7 to 10.0 ± 1.9 (μU/ml) 24 months after surgery in XGB patients (p < 0.05); no significant changes were detected in control individuals. Median HOMA-IR index increased from 1.31 (interquartile range, 1.01-1.68) to 2.20 (interquartile range, 1.57 - 2.60) 24 months after XGB, (p < 0.003). Median HOMA-IR index of control subjects remained unchanged at the end of the study. Serum apoB concentration increased from 61.5 ± 3.4 to 79.0 ± 7.8 (μg/ml) in XGB patients (p < 0.03). Serum apoB levels remained within normal ranges in both periods of the study in control subjects. HFC significantly increased in 2 of the 4 segments 24 months after XGB: right posterior hepatic lobe (from 5.3 ± 0.2% to 6.0 ± 0.2%, p > 0.04) and right anterior hepatic lobe (from 5.8 ± 0.2% to 6.6 ± 0.3%, p < 0.02). The average HFC of the four hepatic segments studied slightly increased from 5.4 ± 0.2 to 5.8 ± 0.3 2 years after XGB (p < 0.03). No significant changes were found in HFC in the control subjects at the end of the study.ConclusionsElective XGB increases HFC, HOMA-IR index and serum apoB concentration. These results support the notion that XGB is a risk factor non-alcoholic fatty liver disease and other IR – associated disease conditions.

Alteration of fatty infiltration grades of the liver in sonography as an outcome of cholecystectomy

“…Current prospective and retrospective studies suggest a strong association between cholecystectomy and NAFLD. [3,[10][11] Cholecystectomy was emphasized as an independent risk factor for NAFLD. [10,14] Furthermore, Shen et al…”

The Influence of Cholecystectomy at Young Age on the Course of Metabolic Syndrome in Women

“…Так, в энтеро-цитах и гепатоцитах активация фарнезоидного Х-рецептора (FXR) блокирует синтез желчных кислот из холестерина посредством инактивации цитохрома С450 (СYP27A1) и увеличивает экс-прессию переносчиков желчных кислот, что спо-собствует их энтерогепатической циркуляции. Взаимодействие желчных кислот с FXR L-клеток кишечника вызывает снижение экспрессии про-глюкагона и глюкагоноподобного пептида-1 (ГПП-1), регулирующих чувство насыщения [5]. Эффекты активации TGR5 (мембранного рецеп-тора желчных кислот) наиболее активно изуча-ются, и согласно известным механизмам влияния TGR5 желчные кислоты представляются регуля-торами углеводного и основного обменов, бло-каторами воспаления в ткани печени, эндотелии и жировой ткани, регуляторами функции щито-видной железы на периферии [9].…”

“…Анализ данных литературы показывает, что сочетание ЖКБ и НАЖБП имеет следующие особенности: у 55% пациентов с ЖКБ наблю-даются морфологические признаки НАЖБП, у 10% пациентов с ЖКБ отмечены выраженные фибротические изменения печени, а 19,8% па-циентов с НАЖБП страдают ЖКБ [5]. Более того, в общей популяции ЖКБ встречается у 13%, а в популяции с НАЖБП частота выяв-ления ЖКБ достигает 34,3%.…”

Pathophysiological connections between gallstone disease, insulin resistance, and obesity

“…We found that liver triglycerides, quantified by magnetic resonance imaging, were increased in two over four liver segments after 24 months of the surgery, whereas no changes were noted in control individuals during the same period of time. Similarly, HOMA‐IR index increased by approximately 70% after 24 months in patients with cholecystectomy whereas it remained unchanged in control patients . These results substantiate the hypothesis that the GB regulates hepatic triglyceride content and systemic insulin sensitivity in humans with GSD.…”