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  Fatty Liver Disease

The Global Epidemiology of Non-alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
  Reported by Jules Levin
AASLD 2017 Oct 20-24 Wash DC


Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Type 2 diabetes mellitus (DM) is a known risk factor for both NAFLD and development of fibrosis. Our aim was to assess the global prevalence of NAFLD in patients with DM.
Methods: PubMed, Ovid-Medline, EMBASE and Web of Science were searched from January 1989 to May 2017 for terms involving Non-alcoholic fatty liver disease and type 2 diabetes mellitus. Morbidly obese and pediatric groups were excluded. Regions were classified according to the World Health Organization (WHO). All studies were reviewed by three independent investigators. Pooled NAFLD prevalence was calculated using random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression. The NAFLD prevalence estimates were stratified by region, diagnostic method, mean BMI and mean age.
Results: Of the 1,589 studies analyzed, 96 studies were included from 26 countries with a total sample size of 94,843 patients with DM. The pooled overall global NAFLD prevalence among patients with DM was 57.19% (53.53% 60.77%). The highest NAFLD prevalence in diabetics was reported from Europe (67.43% [61.87% 72.53%]), while Africa had the lowest prevalence (16.67% [11.76% 23.08%]). The prevalence of NAFLD in diabetics increased with age (44.6% among aged 40-49 vs 60.6% among 60-69) and BMI (53.9% in BMI<25 vs 58.9% when BMI>25). The estimated NAFLD prevalence in diabetics was higher when the diagnosis was made by radiological methods (58.06%), as comapred to histologic diagnosis (45.87%) and diagnosis based on elevated liver enzyme (54.99%). The overall prevalence of NASH among patients with DM was 50.09% (44.66% by histologic criteria and 54.92% by non-invasive methods).
Conclusion: This meta-analysis reveals that the prevalence of NAFLD is more than two times higher among patients with DM than the rates for the general population. As expected, NAFLD prevalence in DM increased in parallel to increasing age and higher BMI. Prevalence rates of NAFLD in diabetics showed large variations in different parts of the world. In conjunction with increasing evidence that NAFLD in diabetics is more aggressive, this data regarding the high prevalence rates in DM raises the prospect of increasing burden of this important chronic liver disease worldwide.