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Review
. 2025 Mar;41(3):902-909.
doi: 10.12669/pjms.41.3.11362.

Association between fatty liver disease and risk of microvascular complications in Type-2 diabetes mellitus: A systematic review and meta-analysis

Jiawei Shao  1 , Mi Zhou  2 , Xiaoqing Xie  3 , Shaobo Lan  4
Affiliations
Review

Association between fatty liver disease and risk of microvascular complications in Type-2 diabetes mellitus: A systematic review and meta-analysis

Jiawei Shao et al. Pak J Med Sci. 2025 Mar.

Abstract

Objective: To summarize the existing evidence on the association between non-alcoholic fatty liver disease (NAFLD) and the probability of microvascular complications in Type-2 diabetes mellitus (T2DM).

Methods: PubMed, EMBASE and Scopus databases search (from inception until October 31, 2023) was done for reports with cross-sectional, cohort or case-control design that included adult participants with T2DM and a documented NAFLD status. The selected studies were required to report on at least one microvascular outcome. Studies reporting adjusted associations were included. Random-effects models were used for all analysis. The pooled effect sizes for the associations were reported as odds ratio (OR) with 95% confidence intervals (CI).

Results: Sixteen studies were analysed. T2DM patients with associated NAFLD had similar risk of neuropathy (OR 1.08, 95% CI: 0.97, 1.21), compared to those without NALFD. NAFLD was associated with slightly lower risk of retinopathy (OR 0.86, 95% CI: 0.75, 0.98; N=10, I2=82.6%) an increased incidence of nephropathy (OR 1.21, 95% CI: 1.14, 1.29; N=12, I2=82.5%), compared to patients with T2DM but no NAFLD.

Conclusion: Diagnosis of NAFLD in patients with T2DM appears to increase the incidence of nephropathy and decrease the risk of retinopathy. Future studies are needed to confirm these observations.

Keywords: Meta-analysis; Microvascular complications; NAFLD; Nephropathy; Neuropathy; Non-alcoholic fatty liver disease; Retinopathy; Type-2 diabetes mellitus.

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Figures

Fig.1
Fig.1
Selection process of studies included in the review.
Fig.2
Fig.2
A) Risk of neuropathy in subjects with diabetes mellitus and associated NAFLD, compared to subjects with diabetes mellitus but no NAFLD; B) Funnel plot for bias of neuropathy.
Fig.3
Fig.3
A) Risk of retinopathy in subjects with diabetes mellitus and associated NAFLD, compared to subjects with diabetes mellitus but no NAFLD; B) Funnel plot for bias of retinopathy.
Fig.4
Fig.4
A) Risk of nephropathy in subjects with diabetes mellitus and associated NAFLD, compared to subjects with diabetes mellitus but no NAFLD; B) Funnel plot for bias of nephropathy.
See this image and copyright information in PMC

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