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Meta-Analysis
. 2019 Jul 31;9(1):11124.
doi: 10.1038/s41598-019-47687-3.

Nonalcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis

Yan Liu  1 , Guo-Chao Zhong  2 , Hao-Yang Tan  3 , Fa-Bao Hao  4 , Jie-Jun Hu  3
Affiliations
Meta-Analysis

Nonalcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis

Yan Liu et al. Sci Rep. .

Abstract

Whether nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of mortality remains controversial. The present study aimed to clarify this issue. A systematic search of PubMed and Embase was conducted through October 2018. Studies providing risk estimates of NAFLD and mortality were included. A random-effects model was employed to calculate summary risk estimates. Subgroup analyses were performed to identify potential effect modifiers. Fourteen studies, involving 498501 subjects and 24234 deaths, were included. Patients with NAFLD were found to be at an elevated risk of all-cause mortality compared with those without [hazard ratio (HR) = 1.34; 95% confidence interval (CI) 1.17-1.54)]. The significantly positive association between NAFLD and all-cause mortality could not be modified by age, sex, follow-up duration, and adjustment for body mass index, diabetes, smoking or hypertension (all Pinteraction > 0.05), and remained in sensitivity analyses. No significant associations of NAFLD with CVD (HR = 1.13; 95% CI 0.92-1.38) and cancer (HR = 1.05; 95% CI 0.89-1.25) mortality were found. In conclusion, NAFLD is a predictor of increased all-cause mortality but not CVD and cancer mortality. These findings have important implications for decision making in public health and clinical practice, and highlight the urgency of developing effective treatments for NAFLD.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The flowchart of identifying relevant studies. NAFLD, nonalcoholic fatty liver disease.
Figure 2
Figure 2
Results of meta-analysis on nonalcoholic fatty liver disease and all-cause mortality. The squares represent the risk estimate for each individual study, with the area reflecting the weight assigned to the study. The horizontal line across each square represents the 95% CI. The diamond represents the summary risk estimate, with width representing 95% CI. HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
Results of meta-analysis on nonalcoholic fatty liver disease and cardiovascular disease mortality. The squares represent the risk estimate for each individual study, with the area reflecting the weight assigned to the study. The horizontal line across each square represents the 95% CI. The diamond represents the summary risk estimate, with width representing 95% CI. HR, hazard ratio; CI, confidence interval.
Figure 4
Figure 4
Results of meta-analysis on nonalcoholic fatty liver disease and overall cancer mortality. The squares represent the risk estimate for each individual study, with the area reflecting the weight assigned to the study. The horizontal line across each square represents the 95% CI. The diamond represents the summary risk estimate, with width representing 95% CI. HR, hazard ratio; CI, confidence interval.
Figure 5
Figure 5
Results of meta-analysis on nonalcoholic fatty liver disease and liver-related mortality. The squares represent the risk estimate for each individual study, with the area reflecting the weight assigned to the study. The horizontal line across each square represents the 95% CI. The diamond represents the summary risk estimate, with width representing 95% CI. HR, hazard ratio; CI, confidence interval.
See this image and copyright information in PMC

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