Highlights
- •Prevalence of NAFLD in patients with type 2 diabetes mellitus is more than 2-fold higher than in the general population.
- •The overall prevalence of NAFLD among patients with type 2 diabetes mellitus is 55.5%.
- •The global prevalence of non-alcoholic steatohepatitis among patients with type 2 diabetes is 37.3%.
- •Of the patients with NAFLD and type 2 diabetes mellitus who undergo liver biopsy, 17% have advanced fibrosis.
Background & Aims
Although non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis
(NASH) and NASH with advanced fibrosis are closely associated with type 2 diabetes
mellitus (T2DM), their global prevalence rates have not been well described. Our aim
was to estimate the prevalence of NAFLD, NASH, and advanced fibrosis among patients
with T2DM, by regions of the world.
Methods
We searched for terms including NAFLD, NASH and T2DM in studies published from January
1989 to September 2018, using PubMed, Ovid MEDLINE®, EMBASE and Web of Science. Strict
exclusion criteria were applied. Regional and global mean prevalence weighted by population
size in each country were estimated and pooled using random-effects meta-analysis.
Potential sources of heterogeneity were investigated using stratified meta-analysis
and meta-regression.
Results
Among 80 studies from 20 countries that met our inclusion criteria, there were 49,419
individuals with T2DM (mean age 58.5 years, mean body mass index 27.9 kg/m2, and males 52.9%). The global prevalence of NAFLD among patients with T2DM was 55.5%
(95% CI 47.3–63.7). Studies from Europe reported the highest prevalence (68.0% [62.1–73.0%]).
Among 10 studies that estimated the prevalence of NASH, the global prevalence of NASH
among individuals with T2DM was 37.3% (95% CI 24.7–50.0%). Seven studies estimated
the prevalence of advanced fibrosis in patients with NAFLD and T2DM to be 17.0% (95%
CI 7.2–34.8). Meta-regression models showed that geographic region and mean age (p <0.5) were associated with the prevalence of NAFLD, jointly accounting for 63.9%
of the heterogeneity.
Conclusions
This study provides the global prevalence rates for NAFLD, NASH, and advanced fibrosis
in patients with T2DM. These data can be used to estimate the clinical and economic
burden of NASH in patients with T2DM around the world.
Lay summary
Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most prevalent
chronic liver disease worldwide. Type 2 diabetes mellitus (T2DM) is an important risk
factor for NAFLD. Additionally, T2DM seems to accelerate the progression of liver
disease in NAFLD. Despite the high prevalence and serious clinical implications of
NAFLD in patients with T2DM, it is usually overlooked in clinical practice. This meta‐analysis
provides evidence of the high prevalence of NAFLD and NASH in patients with T2DM.
In this context, increasing awareness about the importance of NAFLD in patients with
T2DM among all important stakeholders (primary care physicians, specialists, and health
policy makers) must be prioritized.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: July 04, 2019
Accepted:
June 25,
2019
Received in revised form:
June 14,
2019
Received:
December 27,
2018
Identification
Copyright
© 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
