DECODING THE RISK PROFILE OF NON-ALCOHOLIC FATTY LIVER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Authors

  • BABU RAJENDRA PRASAD TR Department of Medicine, Karuna MedicalCollege, Palakkad, Kerala, India.
  • LEENA JOSE Department of Medicine, Karuna MedicalCollege, Palakkad, Kerala, India
  • JAYAKRISHNAN KS Department of Medicine, Karuna MedicalCollege, Palakkad, Kerala, India
  • ANIKET KUMAR CRMI, Department of Medicine, Karuna Medical College, Palakkad, Kerala, India
  • JAMILA HAMEED Emiratus professor,karuna medical college

DOI:

https://doi.org/10.22159/ajpcr.2025v18i1.53230

Keywords:

Non-alcoholic fatty liver diseaseNon-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Type 2 diabetes mellitus, Hypertension, Obesity, Metabolic syndrome

Abstract

Objective: This is a systematic review and meta-analysis that aims to evaluate the prevalence of non-alcoholic fatty liver disease (NAFLD) and the risk factors such as type 2 diabetes mellitus (T2DM), hypertension, obesity, PCOS, and sleep apnea associated with it. NAFLD is one of the most prevalent diseases that affect approximately 40% of diabetic, hypertensive, dyslipidemic obese individuals. Its asymptomatic nature often leads to under diagnosis and progress to severe liver cirrhosis and hepatocellular carcinoma.

Methods: A total of 1819 studies from database from 2019 to 2024 were identified, finally 10 studies were selected, the Statistical Package for the Social Sciences software was used for data analysis.

Results: The analyses across different geographic regions with 620,3969 patients with NAFLD, T2DM prevalence came out to be 15% among males, whereas 22.2% in females. A prevalence of 52.55% was noted in the obese population and 26.74% in lean individuals, with PCOS 43%, metabolic syndrome 75.3%, and sleep apnea 40% and various risk factors were also identified.

Conclusion: This review throws light on the nature of NAFLD, focusing on the need for increased awareness and screening among people at risk, strategies could help avert liver disease progression.

Downloads

Download data is not yet available.

References

Sood V, Alam S, Nagral A, Srivastava A, Deshmukh A, Bavdekar A, et al. Practice recommendations for metabolic dysfunction-associated steatotic liver disease by the Indian society of pediatricgastroenterology, hepatology and nutrition (ISPGHAN). Indian Pediatr. 2024;61(10):919-34. doi: 10.1007/s13312-024-3290-1, PMID 39297398

Younossi ZM, Zelber-Sagi S, Henry L, Gerber LH. Lifestyle interventions in nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol. 2023 Nov;20(11):708-22. doi: 10.1038/s41575-023-00800-4, PMID 37402873

Kang D, Zhao D, Ryu S, Guallar E, Cho J, Lazo M, et al. Perceived stress and non-alcoholic fatty liver disease in apparently healthy men and women. Sci Rep. 2020 Jan 8;10(1):38. doi: 10.1038/s41598-019- 57036-z, PMID 31913326

Masarone M, Rosato V, Dallio M, Gravina AG, Aglitti A, Loguercio C, et al. Role of oxidative stress in pathophysiology of nonalcoholic fatty liver disease. Oxid Med Cell Longev. 2018 Jun 11;2018:9547613. doi: 10.1155/2018/9547613, PMID 29991976

Page MJ. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Lipids Health Dis. 2023 Mar 15;22(1):41.

Egger M, Davey Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629-34. doi: 10.1136/bmj.315.7109.629, PMID 9310563

Cao L, An Y, Liu H, Jiang J, Liu W, Zhou Y, et al. Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: A systematic review and meta-analysis. BMC Med. 2024 Mar 6;22(1):101. doi: 10.1186/s12916-024-03315-0, PMID 38448943

Li J, Zou B, Yeo YH, Feng Y, Xie X, Lee DH, et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2019 May;4(5):389-98. doi: 10.1016/S2468- 1253(19)30039-1, PMID 30902670

Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020 Aug;5(8):739-52. doi: 10.1016/S2468-1253(20)30077-7, PMID 32413340

Tang A, Ng CH, Phang PH, Chan KE, Chin YH, Fu CE, et al. Comparative burden of metabolic dysfunction in lean NAFLD vs non-lean NAFLD- A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(7):1750-1760.e12. doi: 10.1016/j. cgh.2022.06.029, PMID 35863685

Liu Y, Wang W. Sex-specific contribution of lipid accumulation product and cardiometabolic index in the identification of nonalcoholic fatty liver disease among Chinese adults. Lipids Health Dis. 2022;21(1):8. doi: 10.1186/s12944-021-01617-3, PMID 35027066

Cholongitas E, Pavlopoulou I, Papatheodoridi M, Markakis GE, Bouras E, Haidich AB, et al. Epidemiology of nonalcoholic fatty liver disease in Europe: A systematic review and meta-analysis. Ann Gastroenterol. 2021;34(3):404-14. doi: 10.20524/aog.2021.0604, PMID 33948067

Manzano-Nunez R, Santana-Dominguez M, Rivera-Esteban J, Sena E, Bañares J, Frank Tacke NA. Fatty liver disease in patients with polycystic ovary syndrome: A systematic review, meta-analysis, and meta-regression J. Clin Mediterr. 2023 Jan 20;12(3):856.

Jullian-Desayes I, Trzepizur W, Boursier J, Joyeux-Faure M, Bailly S, Benmerad M, et al. Obstructive sleep apnea, chronic obstructive pulmonary disease and NAFLD: An individual participant data meta-analysis. Sleep Med. 2021 Jan;77:357-64. doi: 10.1016/j. sleep.2020.04.004, PMID 32843301

Zhang S, Liu Z, Yang Q, Hu Z, Zhou W, Ji G, et al. Impact of smoking cessation on non- alcoholic fatty liver disease prevalence: A systematic review and meta-analysis. BMJ Open. 2023;13(12):e074216. doi: 10.1136/bmjopen-2023-074216, PMID 38072477

Yuan M, He J, Hu X, Yao L, Chen P, Wang Z, et al. Hypertension and NAFLD risk: Insights from the NHANES 2017-2018 and Mendelian randomization analyses. Chin Med J (Engl). 2024 Feb 20;137(4):457-64. doi: 10.1097/CM9.0000000000002753, PMID 37455323

Lonardo A, Nascimbeni F, Mantovani A, Targher G. Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? J Hepatol. 2018 Feb;68(2):335-52. doi: 10.1016/j.jhep.2017.09.021, PMID 29122390

Shi T, Kobara H, Oura K, Masaki T. Mechanisms underlying hepatocellular carcinoma progression in patients with type 2 diabetes. J Hepatocell Carcinoma. 2021 Feb 11;8:45-55. doi: 10.2147/JHC. S274933, PMID 33604315

Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol. 2017 Jan;14(1):32-42. doi: 10.1038/ nrgastro.2016.147, PMID 27729660

Muzica CM, Sfarti C, Trifan A, Zenovia S, Cuciureanu T, Nastasa R, et al. Nonalcoholic fatty liver disease and type 2 diabetes mellitus: A bidirectional relationship. Can J Gastroenterol Hepatol. 2020 Dec 28;2020:6638306. doi: 10.1155/2020/6638306, PMID 33425804

Tricò D, Caprio S, Rosaria Umano GR, Pierpont B, Nouws J, Galderisi A, et al. Metabolic features of nonalcoholic fatty liver (NAFL) in obese adolescents: Findings from a multiethnic cohort. Hepatology. 2018 Oct;68(4):1376-90. doi: 10.1002/hep.30035, PMID 29665034

Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, et al. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: A long-term follow-up study. Hepatol Commun. 2018;2(1):48-57. doi: 10.1002/hep4.1124, PMID 29404512

Ebrahimi M, Seyedi SA, Nabipoorashrafi SA, Rabizadeh S, Sarzaeim M, Yadegar A, et al. Lipid accumulation product (LAP) index for the diagnosis of nonalcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis. Lipids Health Dis. 2023 Mar 15;22(1):41. doi: 10.1186/s12944-023-01802-6, PMID 36922815

Meijnikman AS, Lappa D, Herrema H, Aydin O, Krautkramer KA, Tremaroli V, et al. A systems biology approach to study nonalcoholic fatty liver (NAFL) in women with obesity. iScience. 2022 Aug 5;25(8):104828. doi: 10.1016/j.isci.2022.104828, PMID 35992074

Subudhi S, Drescher HK, Dichtel LE, Bartsch LM, Chung RT, Hutter MM, et al. Distinct hepatic gene-expression patterns of NAFLD in patients with obesity. Hepatol Commun. 2022 Jan;6(1):77-89. doi: 10.1002/hep4.1789, PMID 34558849

Balakrishnan M, Patel P, Dunn-Valadez S, Dao C, Khan V, Ali H, et al. Women have a lower risk of nonalcoholic fatty liver disease but a higher risk of progression vs men: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021 Jan;19(1):61-71.e15. doi: 10.1016/j. cgh.2020.04.067, PMID 32360810

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses; 2004. Available from: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [Last accessed on 2021 Jan 25].

Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Afshar EE, et al. The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022 Sep;7(9):851-61. doi: 10.1016/S2468-1253(22)00165-0, PMID 35798021

Rocha AL, Faria LC, Guimarães TC, Moreira GV, Cândido AL, Couto CA, et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome: Systematic review and meta-analysis. J Endocrinol Invest. 2017 Dec;40(12):1279-88. doi: 10.1007/s40618- 017-0708-9, PMID 28612285

Musso G, Cassader M, Olivetti C, Rosina F, Carbone G, Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis. Obes Rev. 2013;14(5):417-31. doi: 10.1111/obr.12020, PMID 23387384

Jung HS, Chang Y, Kwon MJ, Sung E, Yun KE, Cho YK, et al. Smoking and the risk of nonalcoholic fatty liver disease: A cohort study. Am J Gastroenterol. 2019 Mar;114(3):453-63. doi: 10.1038/s41395-018- 0283-5, PMID 30353055

Younossi ZM, Rinella ME, Sanyal AJ, Harrison SA, Brunt EM, Goodman Z, et al. From NAFLD to MAFLD: Implications of a premature change in terminology. Hepatology. 2021 Mar;73(3):1194-8. doi: 10.1002/hep.31420, PMID 32544255

Younossi ZM, Stepanova M, Younossi Y, Golabi P, Mishra A, Rafiq N, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2020 Mar;69(3):564-8. doi: 10.1136/gutjnl-2019-318813, PMID 31366455

Eslam M, Sanyal AJ, George J, International Consensus Panel. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020 May;158(7):1999-2014.e1. doi: 10.1053/j.gastro.2019.11.312, PMID 32044314

Arendse LB, Danser AH, Poglitsch M, Touyz RM, Burnett JC, Llorens-Cortes C, et al. Novel therapeutic approaches targeting the renin-angiotensin system and associated peptides in hypertension and heart failure. Pharmacol Rev. 2019 Oct;71(4):539-70. doi: 10.1124/ pr.118.017129, PMID 31537750

Tsuneto A, Hida A, Sera N, Imaizumi M, Ichimaru S, Nakashima E, et al. Fatty liver incidence and predictive variables. Hypertens Res. 2010 Jun;33(6):638-43.

Aneni EC, Oni ET, Martin SS, Blaha MJ, Agatston AS, Feldman T, et al. Blood pressure is associated with the presence and severity ofnonalcoholic fatty liver disease across the spectrum of cardiometabolic risk. Martin J Hypertens. 2015 Jun;33(6):1207-14.

Ma C, Yan K, Wang Z, Zhang Q, Gao L, Xu T, et al. The association between hypertension and nonalcoholic fatty liver disease (NAFLD): literature evidence and systems biology analysis. Bioengineered. 2021;12(1):2187-202. doi: 10.1080/21655979.2021.1933302, PMID 34096467

Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020: The state of the disease. Gastroenterology. 2020 May;158(7):1851-64. doi: 10.1053/j.gastro.2020.01.052, PMID 32061595

Dalmia D, Monga P. Possible genetic involvement in nonalcoholic fatty liver disease. Int J Curr Res. 2024;16(10):30278-82.

Li F, Ye J, Shao C, Zhong B. Compositional alterations of gut microbiota in nonalcoholic fatty liver disease patients: A systematic review and Meta-analysis. Lipids Health Dis. 2021 Feb 26;20(1):22. doi: 10.1186/ s12944-021-01440-w, PMID 33637088

Ahmed HH, Salem AM, Mohamed MR, Shahat AA, Khalil WK, Mohamed SH. Experimental evidences for the promising therapeutic role of Vitis vinifera seed extract against nonalcoholic steatohepatitis. Int J Pharm Pharm Sci. 2015;7(2):417-24.

Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55(7):434-8. doi: 10.1016/S0025- 6196(24)00530-5, PMID 7382552

Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis. 1986;8:283-98. PMID 3086934

Published

07-01-2025

How to Cite

BABU RAJENDRA PRASAD TR, LEENA JOSE, JAYAKRISHNAN KS, ANIKET KUMAR, and J. HAMEED. “DECODING THE RISK PROFILE OF NON-ALCOHOLIC FATTY LIVER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 18, no. 1, Jan. 2025, pp. 23-29, doi:10.22159/ajpcr.2025v18i1.53230.

Issue

Section

Review Article(s)