Faculty Opinions recommendation of Nonalcoholic fatty liver disease and the risk of clinical cardiovascular events: A systematic review and meta-analysis.

Background and Aims: Recent studies have suggested an association between periodontitis and nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. The current systematic review and meta- analysis was conducted with the aim to comprehensively investigate this possible association by identifying all relevant studies and combining their results together. Methods: A comprehensive literature review was conducted utilizing the MEDLINE and EMBASE databases through December 2019 to identify all studies that compared the risk of NAFLD among patients with periodontitis to individuals without periodontitis. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: A total of five studies with 27,703 participants fulfilled the eligibility criteria and were included in the meta-analysis. All five studies reported the magnitude of association between NAFLD and periodontitis that was diagnosed based on the periodontal pocket depth of > 3.5-4 mm. The pooled OR of unadjusted analysis was 1.48 (95%CI: 1.15-1.89; I 2 92%). However, when adjusted results from the primary studies were used, pooled OR decreased to 1.13 and lost its statistical significance (95%CI: 0.95–1.35; I 2 67%). Three studies reported the magnitude of association between NAFLD and periodontitis that was diagnosed based on a clinical attachment level of ≥ 3 mm. The pooled OR of unadjusted analysis was 1.13 (95%CI: 1.07-1.20; I 2 0%). However, when adjusted results from the primary studied were used, pooled OR decreased to 1.08 and lost its statistical significance (95%CI: 0.94–1.24; I 2 58%). Conclusions: The study found a significant association between periodontitis and NAFLD. However, the association lost its significance when various metabolic parameters were adjusted, suggesting that those metabolic conditions, not periodontitis itself, were predisposing factors for NAFLD.

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Abstract 14339: Nonalcoholic Fatty Liver Disease and the Risk of Clinical Cardiovascular Events: A Meta-Analysis

Circulation ◽

10.1161/circ.132.suppl_3.14339 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Toufik Mahfood Haddad ◽

Shadi Hamdeh ◽

Mahesh Anantha Narayanan ◽

Arun Kanmanthareddy ◽

Venkata M Alla

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Publication Bias ◽

Fatty Liver Disease ◽

Cardiovascular Events ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Cross Sectional ◽

Nonalcoholic Fatty Liver

Background: Numerous studies have assessed the association of Nonalcoholic fatty liver disease (NAFLD) withcardiovascular disease (CVD). However, results have been conflicting due to variability in definitionsof NAFLD and ascertainment of CVD, often combining clinical and surrogate endpoints. We therefore systematically reviewed published literature to assess the association between NAFLD and clinical cardiovascular events. Methods: We searched Medline, Cochrane, google scholar, CINAHL, and Web of Sciencedatabasesusing terms “nonalcoholic fatty liver disease”, “cardiovascular disease”, and their combinations to identify studies published through March 2015. Data from selected studies was extracted and meta-analysis was then performed using Random effects model following the PRISMA guidelines. Publication bias and heterogeneity wereassessed. The main outcome measure was Odds ratio (OR) with 95% CI. Clinical CVD was defined as symptomatic coronary artery disease, myocardial infarction, coronary or peripheral intervention, ischemic stroke, and symptomatic peripheral vascular disease. Results: A total of 7 studies with 14634 patients (NAFLD: 4204; controls: 10430) were included in the final analysis. 3 studies were cross- sectional reporting prevalence, while 4 studies were prospective cohort studies reporting incidence. Patients with NAFLD had a significantly higher risk of clinical CVD compared to controls [OR: 3.17; 95% CI: 1.89-5.30, P<0.01) (figure 1A). There was significant heterogeneity (I2=93%). Funnel plot and Begg’s test did not reveal significant publication bias. Separate analyses of the cohort and cross sectional studies and exclusion sensitivity analysis did not alter the findings (figure 1B). Conclusion: NAFLD is associated with a three fold increase in the risk of clinical CVD compared to controls without NAFLD. These results need to be conformed in large prospective studies.

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