Relationship between Hypothyroidism and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis

Weiwei He, Xiaofei An, Ling Li, Xiaoqing Shao, Qian Li, Qiuming Yao, Jin-An Zhang, Weiwei He, Xiaofei An, Ling Li, Xiaoqing Shao, Qian Li, Qiuming Yao, Jin-An Zhang

Abstract

Background: Previous studies propose that hypothyroidism might play a crucial role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), but findings from published studies on the relationship between hypothyroidism and NAFLD are still controversial. Our study aimed to make a comprehensive evaluation of the relationship between hypothyroidism and NAFLD through a meta-analysis.

Methods: PubMed, China Dissertation Database, and EMBASE databases were searched to find observational studies assessing the relationship between hypothyroidism and NAFLD. The pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated to evaluate the strength of the relationship between hypothyroidism and NAFLD through meta-analysis.

Results: Thirteen articles were ultimately included in our meta-analysis. Meta-analysis of the 13 studies found a high correlation between hypothyroidism and NAFLD (OR = 1.52, 95% CI 1.24-1.87, P < 0.001). Meta-analysis of 9 studies providing adjusted ORs found that hypothyroidism was independently correlated with NAFLD (OR = 1.72, 95% CI 1.32-2.23, P < 0.001). Subgroup analysis found that both overt hypothyroidism and subclinical hypothyroidism were significantly correlated with NAFLD, and the pooled ORs were 1.70 (95% CI 1.23-2.36, P = 0.002) and 1.40 (95% CI 1.10-1.77, P = 0.006), respectively. Besides, meta-analysis of studies providing adjusted ORs also found that both overt hypothyroidism and subclinical hypothyroidism were independently correlated with NAFLD, and the pooled ORs were 1.81 (95% CI 1.30-2.52, P < 0.001) and 1.63 (95% CI 1.19-2.24, P = 0.002), respectively.

Conclusion: The meta-analysis provides strong epidemiological evidence for the relationship between hypothyroidism and NAFLD. Both individuals with subclinical and overt hypothyroidism are at higher risk for NAFLD than euthyroid subjects.

Keywords: hypothyroidism; meta-analysis; non-alcoholic fatty liver disease; relationship; subclinical hypothyroidism.

Figures

Figure 1
Figure 1
Flowchart of study selection in the meta-analysis.
Figure 2
Figure 2
Forest plots in the meta-analysis of the relationship between hypothyroidism and non-alcoholic fatty liver disease (NAFLD). (A) Forest plot suggested that hypothyroidism was correlated with NAFLD. (B) Forest plot suggested that hypothyroidism was independently correlated with NAFLD.
Figure 3
Figure 3
Forest plots in the meta-analysis of the relationship between overt hypothyroidism and non-alcoholic fatty liver disease (NAFLD). (A) Forest plot suggested that overt hypothyroidism was correlated with NAFLD. (B) Forest plot suggested that overt hypothyroidism was independently correlated with NAFLD.
Figure 4
Figure 4
Forest plots in the meta-analysis of the relationship between subclinical hypothyroidism and non-alcoholic fatty liver disease (NAFLD). (A) Forest plot suggested that subclinical hypothyroidism was correlated with NAFLD. (B) Forest plot suggested that subclinical hypothyroidism was independently correlated with NAFLD.
Figure 5
Figure 5
Funnel plots in the meta-analysis of the relationship between hypothyroidism and non-alcoholic fatty liver disease (NAFLD). (A) Funnel plot in the meta-analysis of the relationship between overt hypothyroidism and NAFLD. (B) Funnel plot in the meta-analysis of the relationship between subclinical hypothyroidism and NAFLD.

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