Fu Clarissa Elysia, Ng Cheng Han, Yong Jie Ning, Chan Kai En, Xiao Jieling, Nah Benjamin, Bong Shirley Huey Shin, Win Khin Maung, Bwa Aung Hlaing, Lim Wen Hui, Tan Darren Jun Hao, Zeng Rebecca Wenling, Chew Nicholas, Teng Margaret L P, Siddiqui Mohammad Shadab, Oben Jude A, Sanyal Arun J, Wong Vincent Wai-Sun, Noureddin Mazen, Muthiah Mark
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Endocr Pract. 2023 Jan;29(1):33-39. doi: 10.1016/j.eprac.2022.10.007. Epub 2022 Oct 20.
Nonalcoholic fatty liver disease (NAFLD) affects much of the worldwide population and poses a significant burden to the global healthcare. The rising numbers of individuals with NAFLD and instances of mortality point toward the importance of understanding the association causes of mortality in NAFLD. This meta-analysis aimed to seek the associations of NAFLD with all-cause, cardiovascular disease (CVD)-related, liver-related, and cancer-related mortality.
MEDLINE and Embase were searched for articles relating to causes of mortality between NAFLD and non-NAFLD. The DerSimonian and Laird random-effects model was used to analyze adjusted hazard ratios (HR), and a sensitivity analysis was conducted to reduce heterogeneity through a graphical display of study heterogeneity.
Fifteen studies involving 10 286 490 patients were included. Individuals with NAFLD exhibited an increased risk of all-cause mortality (HR, 1.32; 95% CI, 1.09-1.59; P < .01; I = 96.00%), CVD-related mortality (HR, 1.22; 95% CI, 1.06-1.41; P < .01; I = 81.00%), and cancer-related mortality (HR, 1.67; 95% CI, 1.15-2.41; P < .01; I = 95.00%). However, no significant association was found between liver-related mortality and NAFLD (HR, 3.58; 95% CI, 0.69-18.46; P =.13; I = 96.00%). The sensitivity analysis conducted with graphic display of heterogeneity and only population-based studies found similar results.
NAFLD was associated with an increased risk of all-cause, CVD-related, and cancer-related mortality but not liver-related mortality. The finding is likely because of low fibrosis prevalence in the community. However, the significant burden in other causes of mortality beyond the liver points to a need for multidisciplinary efforts to reduce the mortality risks.
非酒精性脂肪性肝病（NAFLD）影响着全球众多人口，给全球医疗保健带来了巨大负担。NAFLD患者数量的不断增加以及死亡率的上升表明了解NAFLD死亡率相关病因的重要性。本荟萃分析旨在探寻NAFLD与全因死亡率、心血管疾病（CVD）相关死亡率、肝脏相关死亡率以及癌症相关死亡率之间的关联。
在MEDLINE和Embase数据库中检索与NAFLD和非NAFLD死亡率相关病因的文章。采用DerSimonian和Laird随机效应模型分析调整后的风险比（HR），并通过研究异质性的图形展示进行敏感性分析以降低异质性。
纳入了15项研究，涉及10286490例患者。NAFLD患者全因死亡率风险增加（HR，1.32；95%CI，1.09 - 1.59；P <.01；I² = 96.00%），CVD相关死亡率风险增加（HR，1.22；95%CI，1.06 - 1.41；P <.01；I² = 81.00%），癌症相关死亡率风险增加（HR，1.67；95%CI，1.15 - 2.41；P <.01；I² = 95.00%）。然而，未发现肝脏相关死亡率与NAFLD之间存在显著关联（HR，3.58；95%CI，0.69 - 18.46；P =.13；I² = 96.00%）。通过异质性图形展示以及仅基于人群的研究进行的敏感性分析得出了类似结果。
NAFLD与全因、CVD相关和癌症相关死亡率风险增加有关，但与肝脏相关死亡率无关。这一发现可能是由于社区中纤维化患病率较低。然而，肝脏以外其他死因的巨大负担表明需要多学科努力来降低死亡风险。
