Association between thyroid function and gallstone disease

AIM： To investigate those associations using data of the population-based Study of Health in Pomerania. METHODS： A study population of 3 749 residents aged 20-79 years without previously diagnosed thyroid disease was available for analyses. Serum TSH was used to assess thyroid function. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on ultrasound. Logistic regression was performed to analyze independent associations between thyroid function and cholelithiasis. RESULTS： There were 385 persons （10.3%） with low （〈0.3 mIU/L）, 3 321 persons （88.6%） with normal and 43 persons （1.2%） with high serum TSH levels （〉3 mIU/L）. The proportion of cholelithiasis among males and females was 14.4% and 25.3%, respectively. Among males, there was an independent relation between high serum TSH and cholelithiasis （OR 3.77; 95%-CI 1.06-13.41; P〈0.05）. Also among males, there was a tendency towards an elevated risk of cholelithiasis in persons with low serum TSH （OR 1.40; 95%-CI 0.96-2.02; P= 0.07）. In the female population, no such relation was identified. CONCLUSION： There is an association between thyroid and gallstone disease with a gender-specific relation between hypothyroidism and cholelithiasis.

Multicausality in fatty liver disease:Is there a rationale to distinguish between alcoholic and non-alcoholic origin?

Apart from alcohol,there are other factors that may induce complications,which resemble alcohol-related liver disorders.In particular,obesity has been brought into focus as a risk factor for fatty liver disease.The term "non-alcoholic" fatty liver disease is commonly used to distinguish between obesity-related and alcohol-related hepatic steatosis.This review uses the epidemiological perspective to critically assess whether it is necessary and useful to differentiate between alcoholic and "nonalcoholic" fatty liver disease.The MEDLINE database was searched using the PubMed search engine,and a review of reference lists from original research and review articles was conducted.The concept to distinguish between alcoholic and "non-alcoholic" fatty liver disease is mainly based on specific pathomechanisms.This concept has,however,several limitations including the common overlap between alcohol misuse and obesityrelated metabolic disorders and the non-consideration of additional causal factors.Both entities share similar histopathological patterns.Studies demonstrating differences in clinical presentation and outcome are often biased by selection.Risk factor reduction is the main principle of prevention and treatment of both disease forms.In conclusion,alcoholic and "non-alcoholic" fatty liver diseases are one and the same disease caused by different risk factors.A shift from artificial categories to a more general approach to fatty liver disease as a multicausal disorder may optimize preventive strategies and help clinicians more effectively treat patients at the individual level.