Abstract
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. 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. 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. 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.
Highlights
The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased substantially during the past decades, and it has become the leading cause of liver disease worldwide, which may be partly attributed to the rising prevalence of obesity [1]
Previous studies propose that hypothyroidism might play a crucial role in the pathogenesis of NAFLD, some observational studies fail to find an obvious association between hypothyroidism and NAFLD
It is more remarkable that our study, which comprised 13 available studies from 11 countries, is the first meta-analysis integrating the evidence for the relationship between hypothyroidism and NAFLD
Summary
The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased substantially during the past decades, and it has become the leading cause of liver disease worldwide, which may be partly attributed to the rising prevalence of obesity [1]. Subclinical hypothyroidism is considered as a disease with an elevated thyroid-stimulating hormone (TSH) level than normal range, normal serum free thyroxine (fT4) level and absence of obvious clinical manifestation. Overt hypothyroidism is defined as a disease with an elevated TSH level and a lower fT4 level, and it may be accompanied by obvious clinical symptoms. Some studies have found that both overt hypothyroidism and subclinical hypothyroidism are associated with cardiovascular diseases and mortality. Other studies have found that either overt hypothyroidism or subclinical hypothyroidism may be associated with other diseases, such as chronic kidney disease, dementia, and fractures [8,9,10]. 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
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