The Prevalence of Non-Alcoholic Fatty Liver Disease in Iranian Children and Adult Population: A Systematic Review and Meta-Analysis
-
Soheil Hassanipour
,
Ehsan Amini-Salehi
,
Farahnaz Joukar
,
Mohammad-Javad Khosousi
,
Farideh Pourtaghi
,
Malek Moein Ansar
,
Marjan Mahdavi-Roshan
,
Forough Heidarzad
,
Golnaz Rashidi-Mojdehi
,
Elham Abdzadeh
,
Azin Vakilpour
,
Fariborz Mansour-Ghanaei
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is the world's most common etiology of chronic liver disease. In this systematic review and meta-analysis, we estimated the prevalence of NAFLD in the Iranian children and adult population.
Methods: A comprehensive search of five international databases, including PubMed, ISI/WOS, ProQuest, Scopus, and Google Scholar, was done from inception to Nov 2022. Studies on NAFLD patients and their risk factors were selected for meta-analysis. The quality of the included studies was assessed by The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional, and cohort studies. The heterogeneity between studies was investigated using Cochran test and I2 statistics. Random and fixed effect models were used for heterogenic and non-heterogenic studies, respectively. We used Comprehensive Meta-Analysis version 3 for conducting meta-analysis.
Results: Twenty studies were finally included. The total prevalence of NAFLD in children, boys, and girls was 6.7% (95% CI: 0.02-0.18), 12.5% (95% CI: 0.04-0.29) and, 10.1% (95% CI: 0.04-0.21), respectively. The total prevalence of NAFLD in obese children, obese boys, and obese girls was 42% (95% CI: 0.18-0.69), 44% (95% CI: 0.13-0.80), and 33 % (95% CI: 0.13-0.62), respectively. The total prevalence of NAFLD in adults was 36.9% (95% CI: 0.31-0.42). The prevalence of NAFLD in men and women was 33.8% (95% CI: 0.27-0.41) and 29.9% (95% CI: 0.21-0.40), respectively.
Conclusion: NAFLD prevalence in Iranian adults and obese children is considerable; however, data about the children population was insufficient.
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27. Motamed N, Rabiee B, Poustchi H, et al (2017). Non-alcoholic fatty liver disease (NAFLD) and 10-year risk of cardiovascular diseases. Clin Res Hepatol Gastroenterol, 41(1):31-8.
28. Motamed N, Khoonsari M, Panahi M, et al (2020). The incidence and risk factors of non-alcoholic fatty liver disease: A cohort study from Iran. Hepat Mon, 20(2):98531.
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50. Nobili V, Alisi A, Valenti L, et al (2019). NAFLD in children: new genes, new diagnostic modalities and new drugs. Nat Rev Gastroenterol Hepatol, 16(9):517-30.
51. Mencin AA, Lavine JE (2011). Advances in pediatric nonalcoholic fatty liver disease. Pediatr Clin North Am, 58(6):1375-92.
52. Vajro P, Lenta S, Socha P, et al (2012). Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr, 54(5):700-13.
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57. Li J, Zou B, Yeo YH, et al (2019). Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 4(5): 389-98.
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60. Rayyan YM, Tayyem RF (2018). Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors. Diabetes Metab Syndr, 12(4): 569-75.
61. Wong S-W, Chan W-K (2020). Epidemiology of non-alcoholic fatty liver disease in Asia. Indian J Gastroenterol, 39(1): 1-8.
62. Khosousi MJ, Mansour-Ghanaei F, Heidarzad F, et al (2022). Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health, 51(10): 2194-206.
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68. Asrani SK, Devarbhavi H, Eaton J, et al (2019). Burden of liver diseases in the world. J Hepatol, 70(1): 151-171.
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2. Younossi ZM, Koenig AB, Abdelatif D, et al (2016). Global epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64(1):73-84.
3. Byrne CD, Targher G (2015). NAFLD: a multisystem disease. J Hepatol, 62(1 Suppl):S47-64.
4. Aller R, Izaola O, Gómez S, et al (2015). Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study. Eur Rev Med Pharmacol Sci, 19(16): 3118-24.
5. Westfall E, Jeske R, Bader AR (2020). Nonalcoholic Fatty Liver Disease: Common Questions and Answers on Diagnosis and Management. Am Fam Physician, 102(10): 603-12.
6. Kneeman JM, Misdraji J, Corey KE (2012). Secondary causes of nonalcoholic fatty liver disease. Therap Adv Gastroenterol, 5(3): 199-207.
7. Bedossa P (2017). Pathology of non-alcoholic fatty liver disease. Liver Int, 37 (Suppl 1): 85-9.
8. Vernon G, Baranova A, Younossi ZM (2011). Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther, 34(3): 274-85.
9. Younossi ZM, Stepanova M, Afendy M, et al (2011). Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol, 9(6):524-30.
10. Loomba R, Sanyal AJ (2013). The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol, 10(11): 686-90.
11. Perumpail BJ, Khan MA, Yoo ER, et al (2017). Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World J Gastroenterol, 23(47): 8263-76.
12. Yu EL, Schwimmer JB (2021). Epidemiology of Pediatric Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken), 17(3): 196-9.
13. Yu EL, Golshan S, Harlow KE, et al (2019). Prevalence of Nonalcoholic Fatty Liver Disease in Children with Obesity. J Pediatr, 207: 64-70.
14. Mazloomzadeh S, Rashidi Khazaghi Z, Mousavinasab N) 2018(. The Prevalence of Metabolic Syndrome in Iran: A Systematic Review and Meta-analysis. Iran J Public Health, 47(4): 473-80.
15. Mirzaei M, Rahmaninan M, Mirzaei M, et al (2020). Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study. BMC Public Health, 20(1): 166.
16. Vaisi-Raygani A, Mohammadi M, Jalali R, et al (2019). The prevalence of obesity in older adults in Iran: a systematic review and meta-analysis. BMC Geriatr, 19(1): 371.
17. Moghaddasifar I, Lankarani KB, Moosazadeh M, et al (2016). Prevalence of Non-alcoholic Fatty Liver Disease and Its Related Factors in Iran. Int J Organ Transplant Med, 7(3): 149-60.
18. Liberati A, Altman DG, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339:b2700.
19. Adibi A, Maleki S, Adibi P, et al (2017). Prevalence of nonalcoholic fatty liver disease and its related metabolic risk factors in Isfahan, Iran. Adv Biomed Res, 6: 47.
20. Amirkalali B, Poustchi H, Keyvani H, et al (2014). Prevalence of non-alcoholic fatty liver disease and its predictors in north of Iran. Iran J Public Health, 43(9): 1275-83.
21. Lankarani KB, Ghaffarpasand F, Mahmoodi M, et al (2013). Non alcoholic fatty liver disease in southern Iran: a population based study. Hepat Mon, 13(5): e9248.
22. Birjandi M, Ayatollahi SM, Pourahmad S, et al (2016). Prediction and Diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD) and Identification of Its Associated Factors Using the Classification Tree Method. Iran Red Crescent Med J, 18(11): e32858.
23. Fattahi N, Sharifi K, Moradi G, et al (2018). Prevalence of non-alcoholic fatty liver disease in Kurdistan province, Iran, 2013–2014: a population based study. Govaresh, 23(2): 107-13.
24. Honarvar B, Bagheri Lankarani K, Keshani P, et al (2017). Dietary determinants of non-alcoholic fatty liver disease in lean and non-lean adult patients: a population-based study in shiraz, southern Iran. Hepat Mon, 17(4): e12295.
25. Mansour-Ghanaei R, Mansour-Ghanaei F, Naghipour M, et al (2018). The role of anthropometric indices in the prediction of non-alcoholic fatty liver disease in the PERSIAN Guilan Cohort study (PGCS). J Med Life, 11(3): 194-202.
26. Motamed N, Maadi M, Sohrabi M, et al (2016). Rural residency has a protective effect and marriage is a risk factor for NAFLD. Hepat Mon, 16(7): e38357.
27. Motamed N, Rabiee B, Poustchi H, et al (2017). Non-alcoholic fatty liver disease (NAFLD) and 10-year risk of cardiovascular diseases. Clin Res Hepatol Gastroenterol, 41(1):31-8.
28. Motamed N, Khoonsari M, Panahi M, et al (2020). The incidence and risk factors of non-alcoholic fatty liver disease: A cohort study from Iran. Hepat Mon, 20(2):98531.
29. Ostovaneh MR, Zamani F, Ansari-Moghaddam A, et al (2015). Nonalcoholic fatty liver: the association with metabolic abnormalities, body mass index and central obesity—a population-based study. Metabolic Syndrome and Related Disorders, 13(7):304-11.
30. Montazerifar F, Karajibani M, Moghaddam AR (2014). Relationship between fatty liver disease and biochemical. Rawal Medical J, 39(1): 15-18.
31. Namakin K, Hosseini M, Zardast M, et al (2017). Prevalence of non-alcoholic fatty liver disease (NAFLD) and its clinical characteristics in overweight and obese children in the south east of Iran. Hepat Mon, 18(12):e83525.
32. Saki F, Karamizadeh Z (2014). Metabolic syndrome, insulin resistance and Fatty liver in obese Iranian children. Iran Red Crescent Med J, 16(5): e6656.
33. TAGHAVI AA, Sharif MR, Kheirkhah D (2015). Fatty liver disease in obese children in Kashan, Iran. Caspian Journal of Pediatrics, 1(1): 17-21.
34. Gheibi S, Maleki F, Safiri S, et al (2019). Prevalence and Predictors of Non-Alcoholic Fatty Liver Disease in Obese and Overweight Children in the Northwest of Iran. Hepat Mon, 19(10):e92199.
35. Adibi A, Kelishadi R, Beihaghi A, et al (2009). Sonographic fatty liver in overweight and obese children, a cross sectional study in Isfahan. Endokrynol Pol, 60(1): 14-9.
36. Alavian SM, Mohammad-Alizadeh AH, Esna-Ashari F, et al (2009). Non-alcoholic fatty liver disease prevalence among school-aged children and adolescents in Iran and its association with biochemical and anthropometric measures. Liver Int, 29(2): 159-63.
37. Rafeey M, Mortazavi F, Mogaddasi N, et al (2009). Fatty liver in children. Ther Clin Risk Manag, 5(2):371-4.
38. Schwimmer JB, Deutsch R, Kahen T, et al (2006). Prevalence of fatty liver in children and adolescents. Pediatrics, 118(4):1388-93.
39. Fernandes DM, Pantangi V, Azam M, et al (2018). Pediatric Nonalcoholic Fatty Liver Disease in New York City: An Autopsy Study. J Pediatr, 200: 174-80.
40. Anderson EL, Howe LD, Jones HE, et al (2015). The Prevalence of Non-Alcoholic Fatty Liver Disease in Children and Adolescents: A Systematic Review and Meta-Analysis. PLoS One, 10(10):e0140908.
41. Peng L, Wu S, Zhou N, et al (2021). Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity. BMC Pediatr, 21(1):122.
42. Jimenez-Rivera C, Hadjiyannakis S, Davila J, et al (2017). Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity. BMC Pediatr, 17(1):113.
43. Fabbrini E, Sullivan S, Klein S (2010). Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology, 51(2):679-89.
44. Sahota AK, Shapiro WL, Newton KP, et al (2020). Incidence of nonalcoholic fatty liver disease in children: 2009–2018. Pediatrics, 146(6): e20200771.
45. Tomah S, Alkhouri N, Hamdy O (2020). Nonalcoholic fatty liver disease and type 2 diabetes: where do Diabetologists stand? Clin Diabetes Endocrinol, 6:9.
46. Kitade H, Chen G, Ni Y, et al (2017). Nonalcoholic Fatty Liver Disease and Insulin Resistance: New Insights and Potential New Treatments. Nutrients, 9(4): 387.
47. Paschos P, Paletas K (2009). Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia, 13(1): 9-19.
48. Zhang QQ, Lu LG (2015). Nonalcoholic Fatty Liver Disease: Dyslipidemia, Risk for Cardiovascular Complications, and Treatment Strategy. J Clin Transl Hepatol, 3(1):78-84.
49. Naghipour M, Joukar F, Salehi EA, et al (2022). The association between age at first pregnancy and number of deliveries with metabolic syndrome and its components: Results from Persian Guilan Cohort Study (PGCS). Iran J Obstet Gynecol Infertil, 25(6):1-11.
50. Nobili V, Alisi A, Valenti L, et al (2019). NAFLD in children: new genes, new diagnostic modalities and new drugs. Nat Rev Gastroenterol Hepatol, 16(9):517-30.
51. Mencin AA, Lavine JE (2011). Advances in pediatric nonalcoholic fatty liver disease. Pediatr Clin North Am, 58(6):1375-92.
52. Vajro P, Lenta S, Socha P, et al (2012). Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr, 54(5):700-13.
53. Brunt EM (2010). Pathology of nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol, 7(4):195-203.
54. Sheka AC, Adeyi O, Thompson J, et al (2020). Nonalcoholic Steatohepatitis: A Review. JAMA, 323(12):1175-83.
55. Anstee QM, Reeves HL, Kotsiliti E, et al (2019). From NASH to HCC: current concepts and future challenges. Nat Rev Gastroenterol Hepatol, 16(7):411-28.
56. Nobili V, Alisi A, Newton KP, et al (2016). Comparison of the phenotype and approach to pediatric vs adult patients with nonalcoholic fatty liver disease. Gastroenterology, 150(8): 1798-810.
57. Li J, Zou B, Yeo YH, et al (2019). Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 4(5): 389-98.
58. Cholongitas E, Pavlopoulou I, Papatheodoridi M, et al (2021). Epidemiology of nonalcoholic fatty liver disease in Europe: a systematic review and meta-analysis. Ann Gastroenterol, 34(3): 404-14.
59. Younossi Z, Anstee QM, Marietti M, et al (2018). Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol, 15(1):11-20.
60. Rayyan YM, Tayyem RF (2018). Non-alcoholic fatty liver disease and associated dietary and lifestyle risk factors. Diabetes Metab Syndr, 12(4): 569-75.
61. Wong S-W, Chan W-K (2020). Epidemiology of non-alcoholic fatty liver disease in Asia. Indian J Gastroenterol, 39(1): 1-8.
62. Khosousi MJ, Mansour-Ghanaei F, Heidarzad F, et al (2022). Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health, 51(10): 2194-206.
63. Amarapurkar D, Kamani P, Patel N, et al (2007). Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol, 6(3): 161-3.
64. Singh SP, Nayak S, Swain M, et al (2004). Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey. Trop Gastroenterol, 25(2): 76-9.
65. Mohan V, Farooq S, Deepa M, et al (2009). Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract, 84(1): 84-91.
66. Das K, Das K, Mukherjee PS, et al (2010). Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology, 51(5): 1593-602.
67. Chen ZW, Chen LY, Dai Hl, et al (2008). Relationship between alanine aminotransferase levels and metabolic syndrome in nonalcoholic fatty liver disease. J Zhejiang Univ Sci B, 9(8): 616-22.
68. Asrani SK, Devarbhavi H, Eaton J, et al (2019). Burden of liver diseases in the world. J Hepatol, 70(1): 151-171.
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| Files | ||
| Issue | Vol 52 No 8 (2023) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i8.13399 | |
| Keywords | ||
| Epidemiology Prevalence Non-alcoholic fatty liver disease Systematic review Meta-analysis Iran | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hassanipour S, Amini-Salehi E, Joukar F, Khosousi M-J, Pourtaghi F, Ansar MM, Mahdavi-Roshan M, Heidarzad F, Rashidi-Mojdehi G, Abdzadeh E, Vakilpour A, Mansour-Ghanaei F. The Prevalence of Non-Alcoholic Fatty Liver Disease in Iranian Children and Adult Population: A Systematic Review and Meta-Analysis. Iran J Public Health. 2023;52(8):1600-1612.
