Clin Gastroenterol Hepatol. 2024 Mar 21:S1542-3565(24)00287-8. doi: 10.1016/j.cgh.2024.03.006. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) now known as metabolic dysfunction associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes (T2D). Our aim was to estimate the most recent global prevalence of NAFLD/MASLD, non-alcoholic steatohepatitis (NASH) now known as metabolic dysfunction associated steatohepatitis (MASH), advanced fibrosis, and mortality among patients with T2D.

METHODS: We systematically searched PubMed and Ovid MEDLINE for terms including NAFLD, NASH, and T2D published 1990-2023 according to PRISMA. The meta-analysis was conducted using a random-effects model. Assessment of bias risk used the Joanna Briggs Institute appraisal tool.

RESULTS: From 3,134 studies included in the initial search, 123 studies (N=2,224,144 patients with T2D) were eligible. Another 12 studies (N=2,733 T2D patients with liver biopsy) were eligible for histologic assessments. The global pooled prevalence of NAFLD/MASLD among patients with T2D was 65.33% (95% CI, 62.35-68.18%). This prevalence increased from 55.86% (42.38-68.53%) in 1990-2004 to 68.81% (63.41-73.74%) in 2016-2021 (p=.073). The highest NAFLD/MASLD prevalence among T2D patients was observed in Eastern Europe (80.62%, 75.72-84.73%), followed by the Middle East (71.24%, 62.22-78.84%), and was lowest in Africa (53.10%, 26.05-78.44%). Among patients with liver biopsy data, the global pooled prevalence of NASH/MASH, significant fibrosis and advanced fibrosis was 66.44% (56.61-75.02%), 40.78% (24.24-59.70%), and 15.49% (6.99-30.99%), respectively. The pooled all-cause mortality was 16.79 per 1,000 Person Years (PY) (10.64-26.40), 4.19 per 1,000 PY (1.34-7.05) for cardiac-specific mortality; 6.10 per 1,000 PY (0.78-4.88) for extra-hepatic cancer-specific mortality; 2.15 per 1,000 PY (0.00-2.21) for liver-specific mortality.

CONCLUSIONS: The prevalence of NAFLD/MASLD among T2D is high and growing. The majority of NAFLD/MASLD patients with T2D have NASH/MASH and a significant proportion have advanced fibrosis.

PMID:38521116 | DOI:10.1016/j.cgh.2024.03.006