背景:尽管非酒精性脂肪性肝病(NAFLD)通常发生在超重或肥胖个体中,它越来越多地在瘦弱人群中被发现。在NAFLD患者中,瘦与全因死亡风险增加之间的关联仍存在争议。我们旨在对文献进行系统回顾和荟萃分析,以评估这种关联,并比较瘦NAFLD患者和非瘦NAFLD患者的长期结局。
方法:对于本系统综述和荟萃分析,我们搜索了PubMed,Embase,科克伦图书馆,WebofScience,中国国家知识基础设施(CNKI),万芳,和中国生物医学文献数据库(CBM)从成立到2021年10月15日,相关原创研究文章没有任何语言限制。我们的主要结果是通过定性综合比较瘦NAFLD患者和非瘦NAFLD患者的全因死亡率。用随机效应模型汇集相对风险(RR)和相应的95%机密间隔(CI)。使用I平方(I²)统计量评估异质性,而使用Egger检验确定发表偏倚。进行亚组和敏感性分析。至于次要结果,我们估计道,心血管,和肝脏相关的死亡率,以及糖尿病的发病率,高血压,肝硬化,通过定量合成,患有NAFLD的瘦小和非瘦小个体的癌症。以人年随访为分母来估计死亡率和发病率。
结果:我们确定了12项研究(n=26,329),其中7例(n=7924)用于评估瘦和非瘦NAFLD患者的全因死亡风险。与非瘦肉患者相比,瘦肉患者的死亡风险更高(RR=1.39,95%CI1.08-1.82,异质性:I²=43%)。在瘦弱的NAFLD人群中,全因死亡率为13.3(95%CI:6.7-26.1)/1000人年,肝脏相关死亡率为3.6(95%CI:1.0-11.7),与心血管相关的死亡率为7.7(95%CI:6.4-9.2)。新发糖尿病的发病率为每1000人年13.7(95%CI8·2-22.7),新发高血压为56.1(95%CI:40.2-77.9),肝硬化为2.3(95%CI:1.0-5.0),癌症为25.7(95%CI:20.3-32.4)。
结论:与非瘦患者相比,瘦患者的全因死亡风险更高。体重指数(BMI)不应用作确定是否需要对NAFLD患者进行进一步观察和治疗的标准。
BACKGROUND: Although nonalcoholic fatty liver disease (NAFLD) commonly occurs in overweight or obese individuals, it is increasingly being identified in the lean population. The association between lean and an increased risk of all-cause mortality among patients with NAFLD remains controversial. We aimed to perform a systematic
review and meta-analysis of the literature to evaluate this association and compare the long-term outcomes of
lean NAFLD patients and non-
lean NAFLD patients.
METHODS: For this systematic
review and meta-analysis, we searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang, and Chinese Biomedical Literature Database (CBM) from inception to October 15, 2021, for relevant original research articles without any language restrictions. Our primary outcome was to compare the all-cause mortality in
lean NAFLD patients and non-
lean NAFLD patients by qualitative synthesis. Relative risks (RRs) and corresponding 95% confidential intervals (CIs) were pooled with a random effect model. Heterogeneity was evaluated using I-squared (I²) statistics while publication bias was determined using Egger\'s tests. Subgroup and sensitivity analyses were performed. As for secondary outcomes, we estimated total, cardiovascular, and liver-related mortality, as well as the incidence of diabetes, hypertension, cirrhosis, and cancer in lean and non-lean individuals with NAFLD by quantitative synthesis. Person-years of follow-up were used as the denominator to estimate the mortality and incidence.
RESULTS: We identified 12 studies (n = 26,329), 7 of which (n = 7924) were used to evaluate the risk of all-cause mortality between lean and non-
lean NAFLD patients. Lean patients with NAFLD were found to be at an elevated risk of death compared to non-lean patients (RR = 1.39, 95% CI 1.08-1.82, heterogeneity: I² = 43%). Among the lean NAFLD population, all-cause mortality was 13.3 (95% CI: 6.7-26.1) per 1000 person-years, 3.6 (95% CI: 1.0-11.7) for liver-related mortality, and 7.7 (95% CI: 6.4-9.2) for cardiovascular-related mortality. The incidence of new-onset diabetes was 13.7 (95% CI 8·2-22.7) per 1000 person-years, new-onset hypertension was 56.1 (95% CI: 40.2-77.9), cirrhosis was 2.3 (95% CI: 1.0-5.0), and cancer was 25.7 (95% CI: 20.3-32.4).
CONCLUSIONS: Lean patients with NAFLD had a higher risk of all-cause death than non-lean patients. Body mass index (BMI) should not be used as a criterion to determine whether further observation and therapy of patients with NAFLD are warranted.