Nonalcoholic Fatty Liver Disease Is an Independent Risk Factor for Nephrolithiasis in Women: Findings from NHANES III.

Abstract

Objective: To determine if radiologically diagnosed nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for nephrolithiasis using data from National Health and Nutrition Examination Survey III (NHANES III). Patients and Methods: NHANES III participants aged 20-74 years who underwent hepatobiliary ultrasound were classified as with NAFLD (moderate or severe hepatic steatosis in absence of other known causes of liver disease; n = 2498) or without NAFLD (controls; n = 9361). Risk of nephrolithiasis caused by NAFLD was estimated using logistic regression with propensity score adjustment. Secondary outcomes included medical stone management, lithotripsy, and surgical stone removal. Results: Participants with NAFLD were older (48.7 ± 0.4 vs 43.3 ± 0.3 years, p < 0.001) and exhibited greater prevalence of all components of metabolic syndrome: obesity (48% vs 21%), impaired glucose tolerance (17% vs 11%), diabetes mellitus (15% vs 6%), hypertension (36% vs 24%), and gout (4% vs 2%) (all p < 0.001). After adjusting for demographic, lifestyle, and metabolic factors, NAFLD was associated with increased risk nephrolithiasis (odds ratio [OR] = 1.29, 95% confidence interval [CI] [1.02-1.61], p = 0.03). The association persisted in women (OR = 1.65, 95% CI [1.17-2.32], p = 0.004) but not in men (OR = 1.04, 95% CI [0.77-1.40], p = 0.80). NAFLD was not associated with increased occurrence of medical management (OR = 1.31, 95% CI [0.84-2.05], p = 0.24), lithotripsy (OR = 1.61, 95% CI [0.83-3.33], p = 0.20), or surgical stone removal (OR = 0.83, 95% CI [0.48-1.44], p = 0.52). Conclusions: In a large U.S. population-based cross-sectional analysis, NAFLD was found to be associated with increased risk of nephrolithiasis in women after adjusting for demographic, clinical, and metabolic factors.