Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population.

Aim: A systematic review of the published literature and meta-analysis was carried out to estimate the prevalence of NAFLD in the Indian population.

Methods: English language literature published until April 2021 was searched from electronic databases. Original data published in any form which had reported NAFLD prevalence in the Indian population were included. The subgroup analysis of prevalence was done based on the age (adults or children) and risk category, i.e., average-risk group (community population, participants of control arm, unselected participants, hypothyroidic individuals, athletes, aviation crew, and army personnel) and high-risk group (obesity or overweight, diabetes mellitus, coronary artery disease, etc.). The prevalence estimates were pooled using the random-effects model. Heterogeneity was assessed with I².

Results: Sixty-two datasets (children 8 and adults 54) from 50 studies were included. The pooled prevalence of NAFLD was estimated from 2903 children and 23,581 adult participants. Among adults, the estimated pooled prevalence was 38.6% (95% CI 32-45.5). The NAFLD prevalence in average-risk and high-risk subgroups was estimated to be 28.1% (95% CI 20.8-36) and 52.8% (95% CI 46.5-59.1), respectively. The estimated NAFLD prevalence was higher in hospital-based data (40.8% [95% CI 32.6-49.3%]) than community-based data (28.2% [95% CI 16.9-41%]). Among children, the estimated pooled prevalence was 35.4% (95% CI 18.2-54.7). The prevalence among non-obese and obese children was 12.4 (95% CI 4.4-23.5) and 63.4 (95% CI 59.4-67.3), respectively.

Conclusion: Available data suggest that approximately one in three adults or children have NAFLD in India.

Keywords: ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; BMI, Body mass index; CAD, Coronary artery disease; CI, Confidence interval; DM, Diabetes mellitus; GBD, Global burden of disease; GDM, Gestational diabetes mellitus; GDP, Gross domestic product; HC, Healthy control; IGT, Impaired glucose tolerance; NAFLD, Non-alcoholic fatty liver disease; NASH, Non-alcoholic steatohepatitis; NPCDCS, National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke; OSA, Obstructive sleep apnea; PCOS, Polycystic ovarian syndrome; UT, Union Territories; diabetes mellitus; fatty liver; metabolic syndrome; obesity; steatohepatitis.

Figure 1

PRISMA flow diagram of the study selection.

Figure 2

Pooled estimates of NAFLD prevalence by the random-effects model in children.

Figure 3

Pooled estimates of NAFLD prevalence by the random-effects model in adults.

Figure 4

Pooled estimates of NAFLD among average-risk adults.

Figure 5

Pooled estimates of NAFLD among high-risk adults.

Figure 6

Summary of the quality of the included studies.

Supplementary Figure

Funnel plot showed marked asymmetry.