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

Shalimar, S.; Elhence, Anshuman; Bansal, Bhavik; Gupta, Hardik; Anand, Abhinav; Singh, Thakur Prashant; Goel, Amit

doi:10.1016/j.jceh.2021.11.010

Cited by 60 publications

(31 citation statements)

References 59 publications

(39 reference statements)

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“…Notably, the high-risk group had a higher prevalence of NAFLD at 52.8%, comparable to our estimate of 55.1% [28]. Conversely, those in the average-risk group were noted to have a lower prevalence of NAFLD at 28.2% compared to our estimate of 25.2% [28]. Despite the significant heterogeneity among studies and sampling bias, the above findings of the Indian analysis reflect similarly in our study, which found a significant association between NAFLD and metabolic syndrome, general obesity, central obesity, diabetes, dysglycaemia, dyslipidaemia and hypertension.…”

Section: Discussionsupporting

confidence: 88%

“…The high-risk group consisted of obesity, overweight, pre-diabetes, diabetes mellitus, coronary artery disease, metabolic syndrome, obstructive sleep apnoea, polycystic ovarian syndrome and elevated liver enzymes. Notably, the high-risk group had a higher prevalence of NAFLD at 52.8%, comparable to our estimate of 55.1% [28]. Conversely, those in the average-risk group were noted to have a lower prevalence of NAFLD at 28.2% compared to our estimate of 25.2% [28].…”

Section: Discussionsupporting

confidence: 81%

“…At the time of the final analysis of our study, a systemic review and meta-analysis of the prevalence of NAFLD in India was published [28]. This study was the first meta-analysis of all published studies on NAFLD in India.…”

Section: Discussionmentioning

confidence: 99%

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Non-alcoholic fatty liver disease in the South Asian Region: A systematic review and meta-analysis

Niriella

Ediriweera

Withanage

et al. 2022

Preprint

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Objectives We estimated the prevalence and effect sizes of associations for NAFLD, the commonest chronic liver disease worldwide, among South-Asian adults. Design We searched the PubMed database, using search terms "Prevalence of NAFLD (Non-Alcoholic Fatty Liver Disease)" AND "South Asia" AND South Asian countries ("Afghanistan", "Bangladesh", "Bhutan", "India", "Maldives", "Nepal", "Pakistan" and "Sri Lanka"). We included descriptive, epidemiological studies with satisfactory methodology, reporting the prevalence of NAFLD with a valid diagnostic method (ultrasound/CT imaging, biochemistry, histology). The quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Two authors screened and extracted data independently. A random-effects meta-analysis of prevalence and effect sizes of associations of NAFLD was performed. Gender, urban/rural setting, general population and individuals with metabolic diseases (MetD) stratified the analysis. Results Thirty-two articles were included in the systematic review, and 21 publications were included in the meta-analysis after quality assurance. The pooled overall prevalence of NAFLD in the general population was 25.2% [95%CI 20.3-30.5%] with high heterogeneity (k=9; Q=251.6, DF=8, P<0.0001, I 2 =96.8%). The prevalence was similar among men and women (Q=0.10, DF=1, P=0.746). The NAFLD prevalence in the rural communities were 26.0% (95%CI: 18.2–34.5%) and it was 26.6% (95%CI: 20.5-33.1%) in urban communities without significant differences in the prevalence (Q=0.01, DF=1, P= 0.916). The pooled overall prevalence of NAFLD in patients with MetD was 55.1% [95%CI 47.4-62.8%] with high heterogeneity (k=8; Q=53.8, DF=7, P<0.0001, I 2 =85.2%). The pooled overall prevalence of NAFLD in the non-obese population was 11.7% [95%CI 7.0-17.3%] (k=6; Q=170.1, DF=5, P<0.0001; I2=97.1%). The pooled prevalence of non-obese NAFLD in the NAFLD population was 43.4% [95%CI 28.1-59.4%] [k=6; Q=181.1; P<0.0001; I2=97.2%]. Meta-analysis of binary outcomes showed presence of NAFLD in South Asian population was associated with diabetes mellitus [RR-2.03 (1.56-2.63)], hypertension [RR-1.37 (1.03-1.84)], dyslipidaemia [RR-1.68 (1.51-1.88)], general obesity [RR-2.56 (1.86-3.51)], central obesity [RR-2.51 (1.69-3.72)] and metabolic syndrome [RR-2.86 (1.79-4.57)]. Gender was not associated with NAFLD. Conclusions The overall prevalence of NAFLD among adults in South Asia is high, especially those with metabolic abnormalities, and a considerable proportion are non-obese. In the South Asian population, NAFLD was associated with MetD.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 81%

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Non-alcoholic fatty liver disease in the South Asian Region: A systematic review and meta-analysis

Niriella

Ediriweera

Withanage

et al. 2022

Preprint

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“…A recent meta-analysis from India reported the estimated pooled prevalence to be 38.6% in adults and alarmingly 35.4% in children. 22 As reported by Draijer et al, only one-third of children with pediatric NAFLD have a resolution of steatosis as adults, while 6% develop NAFLD-related fibrosis. 23 These two results highlight the need for increased inclusivity and representation of a South East Asian cohort in studies pertaining to NAFLD.…”

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confidence: 88%

Editorial: The tip of the non‐alcoholic fatty liver disease iceberg—the more we know, the smaller it gets?

Biswas,

Shalimar

2023

JGH Open

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“…The global prevalences of NAFLD and NASH are estimated to be 25% and 1.5% -6.5%, respectively. In India, 38.6% adults and 35.4% children have been found to suffer from NAFLD [6].…”

Section: Introductionmentioning

confidence: 99%

A Review on the Role of Low Glycemic Index Foods for Glycemic Control in Chronic Liver Disease

Bhoite¹,

Joshi²,

Pratti³

et al. 2023

FNS

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Liver is an essential organ that maintains fasting and postprandial blood glucose response via various metabolic pathways. The liver function gradually deteriorates in chronic liver disease (CLD) due to inflammation and destruction of liver parenchyma. The development of glucose intolerance and hepatogenous diabetes (HD) in patients with CLD is an inevitable event. Diabetes and CLD can coexist, and function synergistically to cause unfavorable clinical consequences, including poor treatment outcomes and frequent hospitalization. The complications associated with liver disease (malnutrition, hypoglycemia, acute kidney injury, lactic acidosis, etc.) and lack of guidelines limit pharmacological management of HD. Dietary recommendations by The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines (2019), suggested weight reducing hypocaloric diet along with adequate branched-chain amino acid (BCAA) and micronutrient consumption to improve steatosis and insulin sensitivity in patients with CLD. Dietary glycemic index controls prognosis of obesity, non-alcoholic fatty liver disease (NAFLD) and diabetes. The importance of low GI diet in reducing fasting blood glucose, hepatic glucose influx and fat accumulation, thereby improving weight loss and NAFLD score, is being published in patients with diabetes or liver disease. Several countries have already incorporated GI into their national health policies, for identification of the nutrient value, resulting in establishment of worldwide GI and glycemic load tables for specific food items. However, the apparent complexity of GI and lack of low GI meal choices need to be resolved in order to enhance patient's quality of life, health and well-being. Low GI nutritional supplements, comprising of balanced proportion of carbohydrate, protein, BCAAs, fibers and micronutrients, may reduce the complexity related to dietary management of HD. The review summarizes the importance of nutritional management in HD with focus on low GI diet in people with CLD.

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

Cited by 60 publications

References 59 publications

Non-alcoholic fatty liver disease in the South Asian Region: A systematic review and meta-analysis

Non-alcoholic fatty liver disease in the South Asian Region: A systematic review and meta-analysis

Editorial: The tip of the non‐alcoholic fatty liver disease iceberg—the more we know, the smaller it gets?

A Review on the Role of Low Glycemic Index Foods for Glycemic Control in Chronic Liver Disease

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