Association between cholecystectomy and the risk of new-onset metabolic dysfunction-associated steatotic liver disease: a risk-stratified cohort study.

Cholecystectomy has been reported to be associated with an increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD), but the extent and modifying factors of this association remain unclear. We analyzed 661,122 individuals enrolled from January 1, 2009 to December 31, 2019 in the Korean National Health Insurance Service-National Sample Cohort. Among them, 4,664 patients who underwent cholecystectomy were matched by age, sex, and other factors. MASLD was defined using a fatty liver index > 60. The cholecystectomy group had a 1.48-fold higher risk of MASLD compared to those without cholecystectomy. This risk was modified by the presence of underlying cardiometabolic risk factors. Compared to patients with fewer than three cardiometabolic risk factors and no cholecystectomy, the risk of MASLD increased 4.45-fold in patients with cholecystectomy and ≥ 3 cardiometabolic risk factors. In contrast, those with fewer than three risk factors showed only a 1.22-fold increase. Multivariate analysis including interaction terms showed an adjusted hazard ratio of 5.26 (95% CI, 2.35-11.78) for patients with cholecystectomy and ≥ 3 cardiometabolic risk factors. Cholecystectomy increases the risk of MASLD, particularly in individuals with multiple cardiometabolic risk factors. Comprehensive screening and aggressive management of these factors are essential before and after cholecystectomy.