Keywords
Non-alcoholic Fatty Liver Disease
Elastography Transient
Liver Fibrosis
Population Health
NHANES
Categories
How to Cite
Abstract
Background Cholecystectomy is a common surgical procedure, yet its long-term metabolic consequences on liver health remain poorly understood. The temporal association between time since cholecystectomy and hepatic steatosis and fibrosis was evaluated using data from a nationally representative US population. Methods We analyzed data from the 2017~2020 National Health and Nutrition Examination Survey (NHANES) cycles, focusing on participants with available data on vibration-controlled transient elastography (VCTE), liver stiffness measurements (LSM), controlled attenuation parameter (CAP), and the FIB-4 index. Adults aged ≥20 years without viral hepatitis, malignancy, or liver disease were included. Cholecystectomy exposure was categorized by time since surgery: no cholecystectomy, 0~5 years, 6~10 years, and >10 years. Weighted linear and logistic regression models assessed associations with CAP, LSM, and FIB-4, adjusting for demographic, metabolic, and lifestyle factors. Sensitivity analyses using inverse probability of treatment weighting (IPTW) were conducted to assess robustness. Results Among 6,246 eligible adults, cholecystectomy was independently associated with increased odds of hepatic steatosis (CAP > 248 dB/m), particularly with longer postoperative durations (OR: 1.141 for >10 years, p<0.001). However, no significant association was found for log-transformed CAP values after full covariate adjustment. In contrast, cholecystectomy showed a dose-response relationship with liver stiffness: compared to controls, log-LSM values progressively increased with time since surgery (β for >10 years = 0.179, p<0.001), corresponding with higher odds of LSM-defined fibrosis (OR: 1.713~2.005, p<0.001). Associations with FIB-4 were mixed: early postoperative periods were associated with lower FIB-4 levels, while longer-term periods showed slight increases in fibrosis classification. All key findings remained consistent in IPTW analyses, with E-values indicating robustness to unmeasured confounding. Conclusions In this cross-sectional analysis of a nationally representative US population, cholecystectomy was associated with increased hepatic steatosis and fibrosis, with distinct time-related patterns. The risk of steatosis appeared to rise progressively with longer postoperative durations, while fibrosis was most prominent in the early postoperative period. These findings highlight the potential need for liver health monitoring in individuals with a history of cholecystectomy, especially those with metabolic risk factors.
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