Background Nonalcoholic fatty liver disease (NAFLD) is increasingly identified in patients with inflammatory bowel disease (IBD), but there are few systematic reviews and meta-analyses of the studies of NAFLD in IBD patients. Methods MEDLINE, Web of Science, Cochrane Library, and Scopus were searched (until August 2018) to identify observational studies that reported the prevalence and risk factors for NAFLD in IBD patients. Pooled prevalence, odds ratios (OR), mean difference (MD), and 95% confidence intervals (95% CI) were calculated. Study quality was assessed using the modified Newcastle-Ottawa scale. Results Of the 662 citations evaluated, 19 studies (including 5620 subjects) reported the prevalence of NAFLD in IBD population and were included for the analysis. The overall pooled prevalence was 27.5% (95% CI, 20.7%–34.2%). The prevalence was higher in older patients (MD = 8.22; 95% CI, 6.22–10.22), type 2 diabetes (OR = 3.85; 95% CI, 2.49–5.95), hypertension (OR = 3.18; 95% CI, 2.36–4.28), obesity (OR = 2.79; 95% CI, 1.73–4.50), insulin resistance (OR = 6.66; 95% CI, 1.28–34.77), metabolic syndrome (OR = 4.96; 95% CI, 3.05–8.05), chronic kidney disease (OR = 4.83; 95% CI, 1.79–13.04), methotrexate use (OR = 1.76; 95% CI, 1.02–3.06), surgery for IBD (OR = 1.28; 95% CI, 1.02–1.62), and longer duration of IBD (MD = 5.60; 95% CI, 2.24–8.97). Conclusions We found that NAFLD was not uncommon in the IBD population. Older age, metabolic risk factors, methotrexate use, prior surgery, and longer duration of IBD are predictors for the presence of NAFLD in IBD. Screening of NAFLD might be recommended among IBD patients with the aforementioned factors.
ObjectiveAs a subgroup of nonalcoholic fatty liver disease (NAFLD), patients with non‐obese NAFLD may also have an increased risk of adverse hepatic and metabolic outcomes. We aimed to estimate the prevalence and incidence of non‐obese NAFLD and to describe its clinical characteristics in this systematic review and meta‐analysis.MethodsWe performed a systematic search of 1235 citations published up to Mar 2020. Meta‐analyses, stratified analyses and meta‐regression were all performed.ResultsOf the 46 studies included, 28 cross‐sectional and longitudinal studies of 155 846 non‐obese participants reported a pooled NAFLD prevalence of 14.5% (95% confidence interval [CI] 12.3%‐17.1%). A multivariate meta‐regression analysis showed the trend that the prevalence varied by their geographical location. Further stratified analyses showed that NAFLD was relatively prevalent among people aged ≥45 years (16.2%; 95% CI 10.8‐23.4) and those in South America (25.7%; 95% CI 24.4‐27.0). The PNPLA3 rs738409 gene polymorphism was more frequently observed in non‐obese NAFLD than in both obese NAFLD and non‐obese controls, while the metabolic profiles of non‐obese NAFLD were less severe than those of the obese NAFLD group. Patients with non‐obese NAFLD had 4.81‐fold and 5.43‐fold higher risk of diabetes mellitus and metabolic syndrome, respectively, than the non‐obese controls.ConclusionsNon‐obese NAFLD is common, particularly in South America and among people aged ≥45 years. Metabolic diseases and PNPLA3 rs738409 gene polymorphism are more frequent in the non‐obese NAFLD group than in non‐obese controls.
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