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| Relationship of non‑alcoholic fatty liver disease and the risk of ischemic stroke: a meta‑analysis |
| 1,2YaoZhicui,1LiXiaoling,1RenPeng,1WangWentao,1LiZengning |
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Department of Nutrition, The First Hospital of Hebei Medical University, Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang
050031, Hebei, China; 2College of Nursing，Hebei University of Chinese Medicine，Shijiazhuang 050200, Hebei, China |
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Abstract Objectives Several studies have emerged indicating that ischemic stroke is associated with nonalcoholic fatty liver
disease (NAFLD), and we aimed to systematically review and quantify the association between ischemic stroke and NAFLD. Methods
PubMed, the Web of Science, China Academic Journals Full-text Database, Wanfang Data, the Cochrane Library, Chinese biomedical
literature and Embase were searched (until January 2020) for studies examining the relationship of NAFLD and ischemic stroke. The
odds ratio (OR) value and 95% confidence interval (CI) of the included studies were pooled. At the same time, the subgroup analysis
was conducted according to region, diagnostic method and serum transaminase level. Results Nine articles met inclusion criteria, with
a total of 4, 206 individuals. A significant association was found between NAFLD and ischemic stroke in eight studies (OR = 2.53,
95%CI=1.83-3.49). No significant heterogeneity was detected among studies in all comparisons. These results remained essentially
unchanged after excluding any of the studies in the sensitivity analysis. Subgroup analysis by continent showed that, in Europe and
America, the combined risk of NAFLD patients occurred ischemic stroke was 2.17 (95%CI=1.03-4.58); in Asia, the risk was 3.23
(95%CI=1.83-5.7); in Africa, the risk was 2.28 (95%CI=1.44-3.61). Subgroup analysis by different methods of diagnosing fatty liver
showed that diagnostic methods may be a confounding factor affecting the relationship between NAFLD and ischemic stroke risk
(abdominal ultrasound diagnosis, OR=2.60, 95%CI=1.87-3.61; liver biopsy diagnosis, OR=1.08, 95%CI=0.18-6.52). Subgroup analysis
by serum transaminase levels showed that the levels of ALT were significantly associated with an increased risk of ischemic stroke
in NAFLD patients (the mean difference of ALT was 1.14 U/L, 95%CI=0.68-1.61). The levels of AST were significantly associated
with an increased risk of ischemic stroke in NAFLD patients (the mean difference of AST was 0.57 U/L, 95%CI=0.25-0.80). The
level of GGT was significantly associated with an increased risk of ischemic stroke in NAFLD patients (the mean difference of GGT
was 1.08 U/L, 95%CI=0.38-1.78). Conclusions This meta⁃analysis indicated that nonalcoholic fatty liver disease can increase the
risk incident of ischemic stroke.
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Received: 20 March 2021
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