Systematic review and meta‐analysis to determine the impact of iron depletion in dysmetabolic iron overload syndrome and non‐alcoholic fatty liver disease

Aims Iron reduction has been proposed as treatment for dysmetabolic iron overload syndrome (DIOS) and non‐alcoholic fatty liver disease (NAFLD), but results of published trials are conflicting. We undertook a systematic review and meta‐analysis to determine the impact of phlebotomy in DIOS and NAFLD. Methods We searched multiple databases systematically for studies evaluating the impact of phlebotomy in DIOS and NAFLD. We calculated weighted summary estimates using the inverse variance method. Study quality was assessed using the Cochrane collaboration tool. Results We identified nine studies with 820 patients (427 had phlebotomy, 393 lifestyle changes alone). Iron depletion did not improve the Homeostasis Model Assessment (HOMA) index (mean difference [MD] −0.6; confidence interval (CI), −1.7, 0.5; P = 0.3), insulin level (MD −0.8 mU/L; CI, −5.3, 3.7; P = 0.73), or aspartate aminotransferase (AST) (MD −0.7 IU/L; CI, −3.2, 1.8; P = 0.6) in DIOS and/or NAFLD patients as compared to lifestyle changes alone (five studies, 626 patients). There was mild improvement in alanine aminotransferase (ALT) (MD −6.6 IU/L; CI, −11, −2.1); P