Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis

doi:10.1016/j.jceh.2021.11.010

Journal of Clinical and Experimental Hepatology

Volume 12, Issue 3, May–June 2022, Pages 818-829

https://doi.org/10.1016/j.jceh.2021.11.010 Get rights and content

Background

Non-alcoholic fatty liver disease (NAFLD) contributes to a large proportion of liver disease burden in the world. Several groups have studied the prevalence of NAFLD in the Indian population.

Aim

A systematic review of the published literature and meta-analysis was carried out to estimate the prevalence of NAFLD in the Indian population.

Methods

English language literature published until April 2021 was searched from electronic databases. Original data published in any form which had reported NAFLD prevalence in the Indian population were included. The subgroup analysis of prevalence was done based on the age (adults or children) and risk category, i.e., average-risk group (community population, participants of control arm, unselected participants, hypothyroidic individuals, athletes, aviation crew, and army personnel) and high-risk group (obesity or overweight, diabetes mellitus, coronary artery disease, etc.). The prevalence estimates were pooled using the random-effects model. Heterogeneity was assessed with I².

Results

Sixty-two datasets (children 8 and adults 54) from 50 studies were included. The pooled prevalence of NAFLD was estimated from 2903 children and 23,581 adult participants. Among adults, the estimated pooled prevalence was 38.6% (95% CI 32–45.5). The NAFLD prevalence in average-risk and high-risk subgroups was estimated to be 28.1% (95% CI 20.8–36) and 52.8% (95% CI 46.5–59.1), respectively. The estimated NAFLD prevalence was higher in hospital-based data (40.8% [95% CI 32.6–49.3%]) than community-based data (28.2% [95% CI 16.9–41%]). Among children, the estimated pooled prevalence was 35.4% (95% CI 18.2–54.7). The prevalence among non-obese and obese children was 12.4 (95% CI 4.4–23.5) and 63.4 (95% CI 59.4–67.3), respectively.

Conclusion

Available data suggest that approximately one in three adults or children have NAFLD in India.

Section snippets

Design

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for conducting the study.

Search Strategy

We searched electronic databases including Pubmed/Medline, Embase, Scopus, and Google scholar. The search strategy (Supplementary file 1) included the various terms used for fatty liver disease, the name of states, and major cities of the country. Cross-references from the published articles were manually searched to retrieve the additional literature.

Overall

The literature search identified 50 studies⁵^,9, 10, 11, 12^,¹⁴^,¹⁵^,20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62 (Figure 1, PRISMA flow chart) which provided NAFLD prevalence among children (n = 8) and adults (n = 54). The characteristics of the included studies are summarized in Table 1. Included studies summarized the data from 26,484 participants grouped into 62 datasets.

Discussion

The overall pooled prevalence of NAFLD in India is 38.6% among adults and 35.4% among children. The prevalence is similar in males and females. Our analysis suggests that the prevalence of NAFLD in Indian urban and rural populations is higher than the average estimated global prevalence of 25%.

We calculated an overall pooled prevalence of NAFLD among children (<18 years of age) in India of 35.4% (95% CI: 18.2–54.7%), with a similar prevalence in boys and girls. The pooled prevalence of NAFLD

Credit authorship contribution statement

Shalimar: concept, data extraction, manuscript writing, and critical revision, Anshuman Elhence: data extraction and manuscript writing, Bhavik Bansal: data extraction and manuscript writing, Hardik Gupta: data extraction and manuscript writing, Abhinav Anand: data extraction and manuscript writing, Thakur Prashant Singh: data extraction and manuscript writing, and Amit Goel: concept, data extraction, manuscript writing, and critical revision.

Conflicts of interest

The authors have none to declare.

Acknowledgment

Ms. Sabreena is acknowledged for coordination and data maintenance.

Funding information

None.

Ethics clearance

Not applicable.

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Original ArticlePrevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis

Background

Aim

Methods

Results

Conclusion

Section snippets

Design

Search Strategy

Overall

Discussion

Credit authorship contribution statement

Conflicts of interest

Acknowledgment

Funding information

Ethics clearance

J Hepatol

Ann Epidemiol

J Clin Epidemiol

Int J Cardiol

Indian Heart J

Diabetes Metab Syndr

Diabetes Metab Syndr

Ann Hepatol

Diabetes Metab Syndr

Ann Hepatol

Diabetes Res Clin Pract

Clin Gastroenterol Hepatol

Gastroenterology

Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes

Hepatology

The incidence trends of liver cirrhosis caused by nonalcoholic steatohepatitis via the GBD study 2017

Sci Rep

Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis

Medicine (Baltim)

Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT)

J Assoc Phys India

Prevalence of and risk factors for hepatic steatosis in Northern Italy

Ann Intern Med

The correlation between obesity-related diseases and non-alcoholic fatty liver disease in women in the pre-operative evaluation for bariatric surgery assessed by transient hepatic elastography

Obes Surg

The spectrum of non-alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors

Acta Cir Bras

Prevalence of fatty liver in metabolic syndrome

J Fam Med Prim Care

Fibroscan as a non-invasive predictor of hepatic steatosis in women with polycystic ovary syndrome

Indian J Med Res

High prevalence of non-alcoholic fatty liver disease among healthy male blood donors of urban India

JGH Open

Role of polymerase chain reaction and liver biopsy in the evaluation of patients with asymptomatic transaminitis: implications in diagnostic approach

J Gastroenterol Hepatol

Etiologic types of end-stage chronic liver disease in adults: analysis of prevalence and their temporal changes from a study on native liver explants

Eur J Gastroenterol Hepatol

Prevalence of nonalcoholic fatty liver disease in normal-weight and overweight preadolescent children in Haryana, India

Indian Pediatr

The prevalence of non-alcoholic fatty liver disease and its association with metabolic syndrome and obesity in pediatric population of north India

J Metab Syndrome

Natural history of NASH and HCC

Liver Int

Prevalence of metabolic syndrome among adult population in India: a systematic review and meta-analysis

PLoS One

A simple Indian diabetes risk score could help identify nondiabetic individuals at high risk of non-alcoholic fatty liver disease (CURES-117)

J Diabetes Sci Technol

A study of carotid atherosclerosis in patients with non-alcoholic fatty liver disease

Indian J Clin Biochem

Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey

Trop Gastroenterol

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Sultan Qaboos Univ Med J

Central obesity but not generalised obesity (body mass index) predicts high prevalence of fatty liver (NRFLD), in recently detected untreated, IGT and type 2 diabetes Indian subjects

J Indian Med Assoc

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Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease

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Original Article
Prevalence of Non-alcoholic Fatty Liver Disease in India: A Systematic Review and Meta-analysis