Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis
IntroductionNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergist...
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| Veröffentlicht in: | Gut 2023-11, Vol.72 (11), p.2138-2148 |
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| creator | En Li Cho, Elina Ang, Chong Zhe Quek, Jingxuan Fu, Clarissa Elysia Lim, Lincoln Kai En Heng, Zane En Qi Tan, Darren Jun Hao Lim, Wen Hui Yong, Jie Ning Zeng, Rebecca Chee, Douglas Nah, Benjamin Lesmana, Cosmas Rinaldi Adithya Bwa, Aung Hlaing Win, Khin Maung Faulkner, Claire Aboona, Majd B Lim, Mei Chin Syn, Nicholas Kulkarni, Anand V. Suzuki, Hiroyuki Takahashi, Hirokazu Tamaki, Nobuharu Wijarnpreecha, Karn Huang, Daniel Q. Muthiah, Mark Ng, Cheng Han Loomba, Rohit |
| description | IntroductionNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.MethodsMEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.Results156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2–F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3–F4).ConclusionThis study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.PROSPERO registration numberCRD42022360251. |
| doi_str_mv | 10.1136/gutjnl-2023-330110 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2842452770</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2842452770</sourcerecordid><originalsourceid>FETCH-LOGICAL-b398t-8042b006c7667645c16056243c7684e948f06dfc0ca1ca79d2671a1fcf58a8cc3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQRi0EopeWF2CBLLFhk3ZsJ7bDDlVQkCp1Q9fRxJmAr5wfYqcoW54clxSQWHRl6fOZMyN9jL0ScC6E0hdf13QcQyFBqkIpEAKesIMotS2UtPYpOwAIU1SmrE_YixiPAGBtLZ6zE5UzIar6wH5ehanFwOeF7jDQ6IhPPR-nscDgpm9T8I73mNLGg7-jhXc-EkbifuRpm4nLnGBLiSIfKASf1viO48jXucNEHY9bTDRgypq8wdOP_NllNGGBI4Yt-njGnvUYIr18eE_Z7ccPXy4_Fdc3V58v318XraptKiyUsgXQzmhtdFk5oaHSslQ5sCXVpe1Bd70Dh8KhqTupjUDRu76yaJ1Tp-zt7p2X6ftKMTWDjy4fjSNNa2ykLWVZSWMgo2_-Q4_TuuR7Y6NAa2uEgfoxKrtEZXT12yV3yi1TjAv1zbz4AZetEdDc99jsPTb3PTZ7j3no9YN6bQfq_o78KS4D5zvQDsd_ax8x_gJhFajH</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2841576570</pqid></control><display><type>article</type><title>Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis</title><source>PubMed Central</source><creator>En Li Cho, Elina ; Ang, Chong Zhe ; Quek, Jingxuan ; Fu, Clarissa Elysia ; Lim, Lincoln Kai En ; Heng, Zane En Qi ; Tan, Darren Jun Hao ; Lim, Wen Hui ; Yong, Jie Ning ; Zeng, Rebecca ; Chee, Douglas ; Nah, Benjamin ; Lesmana, Cosmas Rinaldi Adithya ; Bwa, Aung Hlaing ; Win, Khin Maung ; Faulkner, Claire ; Aboona, Majd B ; Lim, Mei Chin ; Syn, Nicholas ; Kulkarni, Anand V. ; Suzuki, Hiroyuki ; Takahashi, Hirokazu ; Tamaki, Nobuharu ; Wijarnpreecha, Karn ; Huang, Daniel Q. ; Muthiah, Mark ; Ng, Cheng Han ; Loomba, Rohit</creator><creatorcontrib>En Li Cho, Elina ; Ang, Chong Zhe ; Quek, Jingxuan ; Fu, Clarissa Elysia ; Lim, Lincoln Kai En ; Heng, Zane En Qi ; Tan, Darren Jun Hao ; Lim, Wen Hui ; Yong, Jie Ning ; Zeng, Rebecca ; Chee, Douglas ; Nah, Benjamin ; Lesmana, Cosmas Rinaldi Adithya ; Bwa, Aung Hlaing ; Win, Khin Maung ; Faulkner, Claire ; Aboona, Majd B ; Lim, Mei Chin ; Syn, Nicholas ; Kulkarni, Anand V. ; Suzuki, Hiroyuki ; Takahashi, Hirokazu ; Tamaki, Nobuharu ; Wijarnpreecha, Karn ; Huang, Daniel Q. ; Muthiah, Mark ; Ng, Cheng Han ; Loomba, Rohit</creatorcontrib><description>IntroductionNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.MethodsMEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.Results156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2–F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3–F4).ConclusionThis study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.PROSPERO registration numberCRD42022360251.</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gutjnl-2023-330110</identifier><identifier>PMID: 37491159</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><subject>Biopsy ; Clinical significance ; Diabetes ; DIABETES MELLITUS ; Diabetes mellitus (non-insulin dependent) ; FATTY LIVER ; Fibrosis ; Hepatology ; Insulin resistance ; Liver diseases ; META-ANALYSIS ; Metabolism ; Morbidity ; NONALCOHOLIC STEATOHEPATITIS ; Pediatrics ; Sensitivity analysis ; Statistical analysis ; Systematic review</subject><ispartof>Gut, 2023-11, Vol.72 (11), p.2138-2148</ispartof><rights>Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b398t-8042b006c7667645c16056243c7684e948f06dfc0ca1ca79d2671a1fcf58a8cc3</citedby><cites>FETCH-LOGICAL-b398t-8042b006c7667645c16056243c7684e948f06dfc0ca1ca79d2671a1fcf58a8cc3</cites><orcidid>0000-0001-6866-0425 ; 0000-0002-9724-4743 ; 0000-0003-2383-5038 ; 0000-0002-1240-1675 ; 0000-0003-4126-307X ; 0000-0002-5533-8987 ; 0000-0002-6232-6343 ; 0000-0002-4845-9991 ; 0000-0002-8297-1569 ; 0000-0003-4634-6616</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37491159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>En Li Cho, Elina</creatorcontrib><creatorcontrib>Ang, Chong Zhe</creatorcontrib><creatorcontrib>Quek, Jingxuan</creatorcontrib><creatorcontrib>Fu, Clarissa Elysia</creatorcontrib><creatorcontrib>Lim, Lincoln Kai En</creatorcontrib><creatorcontrib>Heng, Zane En Qi</creatorcontrib><creatorcontrib>Tan, Darren Jun Hao</creatorcontrib><creatorcontrib>Lim, Wen Hui</creatorcontrib><creatorcontrib>Yong, Jie Ning</creatorcontrib><creatorcontrib>Zeng, Rebecca</creatorcontrib><creatorcontrib>Chee, Douglas</creatorcontrib><creatorcontrib>Nah, Benjamin</creatorcontrib><creatorcontrib>Lesmana, Cosmas Rinaldi Adithya</creatorcontrib><creatorcontrib>Bwa, Aung Hlaing</creatorcontrib><creatorcontrib>Win, Khin Maung</creatorcontrib><creatorcontrib>Faulkner, Claire</creatorcontrib><creatorcontrib>Aboona, Majd B</creatorcontrib><creatorcontrib>Lim, Mei Chin</creatorcontrib><creatorcontrib>Syn, Nicholas</creatorcontrib><creatorcontrib>Kulkarni, Anand V.</creatorcontrib><creatorcontrib>Suzuki, Hiroyuki</creatorcontrib><creatorcontrib>Takahashi, Hirokazu</creatorcontrib><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Wijarnpreecha, Karn</creatorcontrib><creatorcontrib>Huang, Daniel Q.</creatorcontrib><creatorcontrib>Muthiah, Mark</creatorcontrib><creatorcontrib>Ng, Cheng Han</creatorcontrib><creatorcontrib>Loomba, Rohit</creatorcontrib><title>Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis</title><title>Gut</title><addtitle>Gut</addtitle><addtitle>Gut</addtitle><description>IntroductionNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.MethodsMEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.Results156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2–F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3–F4).ConclusionThis study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.PROSPERO registration numberCRD42022360251.</description><subject>Biopsy</subject><subject>Clinical significance</subject><subject>Diabetes</subject><subject>DIABETES MELLITUS</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>FATTY LIVER</subject><subject>Fibrosis</subject><subject>Hepatology</subject><subject>Insulin resistance</subject><subject>Liver diseases</subject><subject>META-ANALYSIS</subject><subject>Metabolism</subject><subject>Morbidity</subject><subject>NONALCOHOLIC STEATOHEPATITIS</subject><subject>Pediatrics</subject><subject>Sensitivity analysis</subject><subject>Statistical analysis</subject><subject>Systematic review</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kc1u1TAQRi0EopeWF2CBLLFhk3ZsJ7bDDlVQkCp1Q9fRxJmAr5wfYqcoW54clxSQWHRl6fOZMyN9jL0ScC6E0hdf13QcQyFBqkIpEAKesIMotS2UtPYpOwAIU1SmrE_YixiPAGBtLZ6zE5UzIar6wH5ehanFwOeF7jDQ6IhPPR-nscDgpm9T8I73mNLGg7-jhXc-EkbifuRpm4nLnGBLiSIfKASf1viO48jXucNEHY9bTDRgypq8wdOP_NllNGGBI4Yt-njGnvUYIr18eE_Z7ccPXy4_Fdc3V58v318XraptKiyUsgXQzmhtdFk5oaHSslQ5sCXVpe1Bd70Dh8KhqTupjUDRu76yaJ1Tp-zt7p2X6ftKMTWDjy4fjSNNa2ykLWVZSWMgo2_-Q4_TuuR7Y6NAa2uEgfoxKrtEZXT12yV3yi1TjAv1zbz4AZetEdDc99jsPTb3PTZ7j3no9YN6bQfq_o78KS4D5zvQDsd_ax8x_gJhFajH</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>En Li Cho, Elina</creator><creator>Ang, Chong Zhe</creator><creator>Quek, Jingxuan</creator><creator>Fu, Clarissa Elysia</creator><creator>Lim, Lincoln Kai En</creator><creator>Heng, Zane En Qi</creator><creator>Tan, Darren Jun Hao</creator><creator>Lim, Wen Hui</creator><creator>Yong, Jie Ning</creator><creator>Zeng, Rebecca</creator><creator>Chee, Douglas</creator><creator>Nah, Benjamin</creator><creator>Lesmana, Cosmas Rinaldi Adithya</creator><creator>Bwa, Aung Hlaing</creator><creator>Win, Khin Maung</creator><creator>Faulkner, Claire</creator><creator>Aboona, Majd B</creator><creator>Lim, Mei Chin</creator><creator>Syn, Nicholas</creator><creator>Kulkarni, Anand V.</creator><creator>Suzuki, Hiroyuki</creator><creator>Takahashi, Hirokazu</creator><creator>Tamaki, Nobuharu</creator><creator>Wijarnpreecha, Karn</creator><creator>Huang, Daniel Q.</creator><creator>Muthiah, Mark</creator><creator>Ng, Cheng Han</creator><creator>Loomba, Rohit</creator><general>BMJ Publishing Group Ltd and British Society of Gastroenterology</general><general>BMJ Publishing Group 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prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis</title><author>En Li Cho, Elina ; Ang, Chong Zhe ; Quek, Jingxuan ; Fu, Clarissa Elysia ; Lim, Lincoln Kai En ; Heng, Zane En Qi ; Tan, Darren Jun Hao ; Lim, Wen Hui ; Yong, Jie Ning ; Zeng, Rebecca ; Chee, Douglas ; Nah, Benjamin ; Lesmana, Cosmas Rinaldi Adithya ; Bwa, Aung Hlaing ; Win, Khin Maung ; Faulkner, Claire ; Aboona, Majd B ; Lim, Mei Chin ; Syn, Nicholas ; Kulkarni, Anand V. ; Suzuki, Hiroyuki ; Takahashi, Hirokazu ; Tamaki, Nobuharu ; Wijarnpreecha, Karn ; Huang, Daniel Q. ; Muthiah, Mark ; Ng, Cheng Han ; Loomba, Rohit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b398t-8042b006c7667645c16056243c7684e948f06dfc0ca1ca79d2671a1fcf58a8cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biopsy</topic><topic>Clinical significance</topic><topic>Diabetes</topic><topic>DIABETES MELLITUS</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>FATTY LIVER</topic><topic>Fibrosis</topic><topic>Hepatology</topic><topic>Insulin resistance</topic><topic>Liver diseases</topic><topic>META-ANALYSIS</topic><topic>Metabolism</topic><topic>Morbidity</topic><topic>NONALCOHOLIC STEATOHEPATITIS</topic><topic>Pediatrics</topic><topic>Sensitivity analysis</topic><topic>Statistical analysis</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>En Li Cho, Elina</creatorcontrib><creatorcontrib>Ang, Chong Zhe</creatorcontrib><creatorcontrib>Quek, Jingxuan</creatorcontrib><creatorcontrib>Fu, Clarissa Elysia</creatorcontrib><creatorcontrib>Lim, Lincoln Kai En</creatorcontrib><creatorcontrib>Heng, Zane En Qi</creatorcontrib><creatorcontrib>Tan, Darren Jun Hao</creatorcontrib><creatorcontrib>Lim, Wen Hui</creatorcontrib><creatorcontrib>Yong, Jie Ning</creatorcontrib><creatorcontrib>Zeng, Rebecca</creatorcontrib><creatorcontrib>Chee, Douglas</creatorcontrib><creatorcontrib>Nah, Benjamin</creatorcontrib><creatorcontrib>Lesmana, Cosmas Rinaldi Adithya</creatorcontrib><creatorcontrib>Bwa, Aung Hlaing</creatorcontrib><creatorcontrib>Win, Khin Maung</creatorcontrib><creatorcontrib>Faulkner, Claire</creatorcontrib><creatorcontrib>Aboona, Majd B</creatorcontrib><creatorcontrib>Lim, Mei Chin</creatorcontrib><creatorcontrib>Syn, Nicholas</creatorcontrib><creatorcontrib>Kulkarni, Anand V.</creatorcontrib><creatorcontrib>Suzuki, Hiroyuki</creatorcontrib><creatorcontrib>Takahashi, Hirokazu</creatorcontrib><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Wijarnpreecha, Karn</creatorcontrib><creatorcontrib>Huang, Daniel Q.</creatorcontrib><creatorcontrib>Muthiah, Mark</creatorcontrib><creatorcontrib>Ng, Cheng Han</creatorcontrib><creatorcontrib>Loomba, Rohit</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural 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China</collection><collection>MEDLINE - Academic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>En Li Cho, Elina</au><au>Ang, Chong Zhe</au><au>Quek, Jingxuan</au><au>Fu, Clarissa Elysia</au><au>Lim, Lincoln Kai En</au><au>Heng, Zane En Qi</au><au>Tan, Darren Jun Hao</au><au>Lim, Wen Hui</au><au>Yong, Jie Ning</au><au>Zeng, Rebecca</au><au>Chee, Douglas</au><au>Nah, Benjamin</au><au>Lesmana, Cosmas Rinaldi Adithya</au><au>Bwa, Aung Hlaing</au><au>Win, Khin Maung</au><au>Faulkner, Claire</au><au>Aboona, Majd B</au><au>Lim, Mei Chin</au><au>Syn, Nicholas</au><au>Kulkarni, Anand V.</au><au>Suzuki, Hiroyuki</au><au>Takahashi, Hirokazu</au><au>Tamaki, Nobuharu</au><au>Wijarnpreecha, Karn</au><au>Huang, Daniel Q.</au><au>Muthiah, Mark</au><au>Ng, Cheng Han</au><au>Loomba, Rohit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis</atitle><jtitle>Gut</jtitle><stitle>Gut</stitle><addtitle>Gut</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>72</volume><issue>11</issue><spage>2138</spage><epage>2148</epage><pages>2138-2148</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><abstract>IntroductionNon-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.MethodsMEDLINE and Embase databases were searched from inception until 13 February 2023. The primary outcomes were the prevalence of NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis in people with T2DM. A generalised linear mixed model with Clopper-Pearson intervals was used for the analysis of proportions with sensitivity analysis conducted to explore heterogeneity between studies.Results156 studies met the inclusion criteria, and a pooled analysis of 1 832 125 patients determined that the prevalence rates of NAFLD and NASH in T2DM were 65.04% (95% CI 61.79% to 68.15%, I2=99.90%) and 31.55% (95% CI 17.12% to 50.70%, I2=97.70%), respectively. 35.54% (95% CI 19.56% to 55.56%, I2=100.00%) of individuals with T2DM with NAFLD had clinically significant fibrosis (F2–F4), while 14.95% (95% CI 11.03% to 19.95%, I2=99.00%) had advanced fibrosis (F3–F4).ConclusionThis study determined a high prevalence of NAFLD, NASH and fibrosis in people with T2DM. Increased efforts are required to prevent T2DM to combat the rising burden of NAFLD.PROSPERO registration numberCRD42022360251.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Society of Gastroenterology</pub><pmid>37491159</pmid><doi>10.1136/gutjnl-2023-330110</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-6866-0425</orcidid><orcidid>https://orcid.org/0000-0002-9724-4743</orcidid><orcidid>https://orcid.org/0000-0003-2383-5038</orcidid><orcidid>https://orcid.org/0000-0002-1240-1675</orcidid><orcidid>https://orcid.org/0000-0003-4126-307X</orcidid><orcidid>https://orcid.org/0000-0002-5533-8987</orcidid><orcidid>https://orcid.org/0000-0002-6232-6343</orcidid><orcidid>https://orcid.org/0000-0002-4845-9991</orcidid><orcidid>https://orcid.org/0000-0002-8297-1569</orcidid><orcidid>https://orcid.org/0000-0003-4634-6616</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0017-5749 |
| ispartof | Gut, 2023-11, Vol.72 (11), p.2138-2148 |
| issn | 0017-5749 1468-3288 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2842452770 |
| source | PubMed Central |
| subjects | Biopsy Clinical significance Diabetes DIABETES MELLITUS Diabetes mellitus (non-insulin dependent) FATTY LIVER Fibrosis Hepatology Insulin resistance Liver diseases META-ANALYSIS Metabolism Morbidity NONALCOHOLIC STEATOHEPATITIS Pediatrics Sensitivity analysis Statistical analysis Systematic review |
| title | Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis |
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