Nonalcoholic fatty liver disease ups risk of death
Nonalcoholic fatty liver disease (NAFLD) heightens the risk of all-cause death but not from cardiovascular diseases (CVD) or cancer, reports a recent meta-analysis.
Accessing the databases of PubMed and Embase, researchers retrieved 14 studies that investigated the effect of NAFLD on mortality risk. Reports that used NAFLD patients as the reference group or assessed mortality in patients undergoing bariatric surgery or liver transplantation were ineligible. The Newcastle-Ottawa scale was used to evaluate methodological quality.
A total of 24,188 deaths were reported in the cumulative sample of 498,259 participants. Pooled analysis revealed a significantly higher death risk in NAFLD patients (hazard ratio [HR], 1.34, 95 percent CI 1.17–1.54), though the evidence had substantial heterogeneity (p<0.01).
Subsequent subgroup analyses found that NAFLD was a significant mortality hazard in women (four studies; HR, 1.49, 1.15–1.93) but not in men (four studies, HR, 1.08, 0.83–1.41). In contrast, there were no meaningful effect modifications according to age, sex, NAFLD severity, the presence of fibrosis or cirrhosis, follow-up duration, comorbidities, and the method used to diagnose NAFLD.
The effect of NAFLD on death risk appeared to be robust, as excluding four studies with large sample sizes did not change the principal findings. NAFLD also exerted a similar effect on the likelihood of death from liver disease (HR, 2.53, 1.23–5.18).
On the other hand, NAFLD had no apparent effect on the risk of death from CVDs (HR, 1.13, 0.92–1.38) and cancer (HR, 1.05, 0.89–1.25).