Is cholecystectomy a real risk factor for Metabolic dysfunction-associated steatotic liver disease (MASLD)? A...

Cholecystectomy due to gallstones is one of the most frequent surgeries worldwide. Observational studies suggest that cholecystectomy may be a risk factor for metabolic dysfunction associated with steatotic liver disease (MASLD). However, gallstone disease and MASLD share common risk factors, which could make cholecystectomy a confounder.

To assess the relationship among cholecystectomy, gallstones, and MASLD in a longitudinal cohort study from a population at high risk of gallbladder diseases.

A longitudinal retrospective cohort study compared consecutive patients undergoing cholecystectomy with a control group composed of patients with their gallbladder intact. All participants had normal liver imaging and biochemistry at baseline. Participants with incomplete clinical records or significant alcohol consumption were excluded. The primary outcome was the development of MASLD after a follow-up of at least 3 years. Cox regression models were used to conduct multivariable analyses.

We included 427 participants 132 in the cholecystectomy group and 295 controls. The mean age was 47.2 years, with 71.7% being female, and 43.6% having gallstone disease. The median follow-up was 9.7 years. In the Cox multivariate analysis, male gender (aHR: 1.56 [1.09-2.24]), gallstone disease (aHR: 2.18 [1.42-3.36]), prediabetes (aHR: 1.56 [1.06-2.3]), diabetes (aHR: 2.39 [1.38-4.13]), and overweight/obesity (aHR: 5.7 [3.19-10.21]) were independent risk factors for MASLD. After adjustment, cholecystectomy was not associated with MASLD incidence (aHR: 0.68 [0.44-1.03]). Sensitivity analyses supported these findings.

Cholecystectomy was not found to significantly influence the incidence of MASLD after adjusting for metabolic risk factors. The risk of developing MASLD is likely driven by metabolic factors and previous gallstone disease.