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. 2015 Oct 15;8(10):17221-34.
eCollection 2015.

Association between vitamin D and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: results from a meta-analysis

Xiang Wang  1 , Weiping Li  2 , Ying Zhang  1 , Yang Yang  1 , Guijun Qin  1
Affiliations

Association between vitamin D and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: results from a meta-analysis

Xiang Wang et al. Int J Clin Exp Med. .

Abstract

The prevalence and impact of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have continued to increase in recent years. Previous reports have shown that hypovitaminosis D is associated with the prevalence and severity of non-alcoholic fatty liver disease (NAFLD). The aim of this study was to systematically evaluate the association of vitamin D levels, as measured by serum 25-hydroxy vitamin D [25(OH)D], with NAFLD and NASH. We searched all of the publications that assessed the association between vitamin D and NAFLD/NASH in the PubMed and EMBASE databases up to November 2014. In total, twenty-nine articles met the eligibility criteria, including twenty-seven studies about NAFLD and four studies about NASH, which were identified and included in the meta-analysis. Twenty-nine cross-sectional and case-control studies evaluated the association between vitamin D and NAFLD/NASH. Twenty-three studies provided data for a quantitative meta-analysis. Compared with the controls, the NAFLD patients had significantly lower levels of 25(OH)D (SMD-0.76; 95% CI-0.97 to-0.54) and were 1.26 times more likely to be vitamin D deficient (OR 1.26, 95% CI: 1.15 to 1.38). Compared with the controls, the NASH patients had significantly lower levels of 25(OH)D (SMD-1.30; 95% CI-2.37 to -0.23). Although the cross-sectional studies did not allow us to determine a causal nexus, our meta-analysis found lower serum 25(OH)D levels in NAFLD/NASH patients than in subjects without NAFLD/NASH, which suggests that hypovitaminosis D could play a role in the pathogenesis of NAFLD/NASH. Further studies are required to establish the causality between vitamin D status and NAFLD.

Keywords: Non-alcoholic steatohepatitis; meta-analysis; non-alcoholic fatty liver disease; vitamin D.

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Figures

Figure 1
Figure 1
Flowchart that shows the process for the selection of studies in the literature.
Figure 2
Figure 2
Meta-analysis of the association between vitamin D and NAFLD with a sub-analysis of NAFLD cases that originated from western countries vs. NAFLD cases that originated from eastern countries using a random-effects model and a standardized mean difference with a 95% confidence interval.
Figure 5
Figure 5
Meta-analysis of the association between lower levels of vitamin D and susceptibility to NAFLD using a fixed-effects model and estimated ORs with a 95% confidence interval.
Figure 3
Figure 3
Meta-analysis of the association between vitamin D and NAFLD with the sub-analysis of NAFLD cases with a BMI ≥ 30 kg/m2 vs. NAFLD cases with a BMI <30 kg/m2 using a random-effects model and standardized mean differences with a 95% confidence interval.
Figure 7
Figure 7
Forest plots of sensitivity of each included publication for continuous outcomes of vitamin D levels.
Figure 4
Figure 4
Meta-analysis of the association between vitamin D and NASH using a random-effects model and a standardized mean difference with a 95% confidence interval.
Figure 8
Figure 8
Forest plots of the sensitivity of each included publication for dichotomous outcomes of vitamin D levels.
Figure 6
Figure 6
Funnel plot to detect publication bias.
See this image and copyright information in PMC

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