Clin Mol Hepatol.
2024 Apr;30(2):235-246. 10.3350/cmh.2023.0485.
Global incidence of adverse clinical events in non-alcoholic fatty liver disease: A systematic review and meta-analysis
- Le MH1,2
- Le DM2,3
- Baez TC3
- Dang H2,4
- Nguyen VH2,5
- Lee K6
- Stave CD7
- Ito T8
- Wu Y9
- Yeo YH10
- Ji F11,12
- Cheung R2,13
- Nguyen MH
2,14
- Affiliations
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- 1Larner College of Medicine at the University of Vermont, Burlington, VT, USA
- 2Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- 3Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
- 4Carver College of Medicine at the University of Iowa, Iowa City, IA, USA
- 5Harvard Medical School, Boston, MA, USA
- 6Stanford University, Stanford, CA, USA
- 7Lane Library, Stanford University School of Medicine, Stanford, CA, USA
- 8Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- 9Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- 10The Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
- 11Department of Infectious Diseases, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- 12National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- 13Division of Gastroenterology and Hepatology, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA, USA
- 14Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
- KMID: 2554429
- DOI: http://doi.org/10.3350/cmh.2023.0485
Abstract
- Background/Aims
Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events.
Methods
We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events.
Results
19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05).
Conclusions
People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.
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