Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis

Elina Cho(National University Hospital), C. Ang(National University Hospital), Jingxuan Quek(National University of Singapore), Clarissa Elysia Fu(National University of Singapore), Lincoln Kai En Lim(National University of Singapore), Zane En Qi Heng(National University of Singapore), Darren Jun Hao Tan(National University of Singapore), Wen Hui Lim(National University of Singapore), Jie Ning Yong(National University of Singapore), Rebecca Wenling Zeng(National University of Singapore), Douglas Chee(National University Hospital), Benjamin Nah(National University Hospital), Cosmas Rinaldi Adithya Lesmana(University of Indonesia), Aung Hlaing Bwa(Myanmar Oxford Clinical Research Unit), Khin Maung Win(Myanmar Oxford Clinical Research Unit), Claire Faulkner(University of Arizona), Majd B. Aboona(University of Arizona), Mei Chin Lim(National University of Singapore), Nicholas Syn(National University of Singapore), Anand V. Kulkarni(Asian Institute of Gastroenterology), Hiroyuki Suzuki(Kurume University), Hirokazu Takahashi(Saga University), Nobuharu Tamaki(University of California San Diego), Karn Wijarnpreecha(University of Michigan), Daniel Q. Huang(National University of Singapore), Mark Muthiah(National University of Singapore), Cheng Han Ng(National University of Singapore), Rohit Loomba(University of California San Diego)
Gut
July 25, 2023
10.1136/gutjnl-2023-330110
Cited by 319

Abstract

Introduction Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM. Methods MEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies. Results 156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I 2 =99.90%) and 31.55% (95% CI 17.12% to 50.70%, I 2 =97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I 2 =100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2–F4), while 14.95% (95% CI 11.03% to 19.95%, I 2 =99.00%) had advanced fibrosis (F3–F4). Conclusion This study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD. PROSPERO registration number CRD42022360251.

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