Lifestyle as well as metabolic syndrome and non-alcoholic fatty liver disease: an umbrella review of evidence from observational studies and randomized controlled trials

Xiaojuan Peng; Juan Li; Hailiang Zhao; Junlong Lai; Junqin Lin; Shaohui Tang

doi:10.1186/s12902-022-01015-5

Lifestyle as well as metabolic syndrome and non-alcoholic fatty liver disease: an umbrella review of evidence from observational studies and randomized controlled trials

BMC Endocr Disord. 2022 Apr 10;22(1):95. doi: 10.1186/s12902-022-01015-5.

Authors

Xiaojuan Peng^#¹, Juan Li^#^{2

3}, Hailiang Zhao^#², Junlong Lai², Junqin Lin², Shaohui Tang⁴

Affiliations

¹ Department of Endocrinology, Liuzhou People's Hospital, Liuzhou, Guangxi, 545006, PR China.
² Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, 510630, PR China.
³ Department of Infectious Disease, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, PR China.
⁴ Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, 510630, PR China. tangshaohui206@163.com.

^# Contributed equally.

Abstract

Background & aims: Recent epidemiological studies have indicated that NAFLD is pathologically associated with a sedentary lifestyle, unhealthy dietary habits and metabolic syndrome. An umbrella review of meta-analyses was performed to summarize the quality of evidence regarding the epidemiologic associations between lifestyle, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD) in regards to risk and treatment.

Methods: We searched PubMed, Web of Science and Embase Database from inception until June 1, 2021. Meta-analyses of observational studies and randomized controlled trials (RCTs) examining the associations of lifestyle as well as metabolic syndrome with NAFLD risk or treatment were screened. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their P values, 95% prediction intervals, heterogeneity, and small-study effects. For meta-analyses of RCTs, outcomes with a random-effect P < 0.005 and a high-GRADE assessment were classified as strong evidence.

Results: A total of 37 publications were included in this review: twenty-two publications reporting 41 meta-analyses of observational studies (37 unique outcomes) and 15 publications reporting 81 meta-analyses of RCTs (63 unique outcomes) met the inclusion criteria. Methodological quality was high for 97% of the included meta-analyses. Quality of evidence was rated high only for the association of sugar-sweetened soda consumption with increased NAFLD risk in meta-analyses of observational studies. Only 3 therapeutic interventions (green tea improving ALT, TG, TC and LDL, omega-3 PUFAs improving HOMR-IR and plasma glucose, and exercise improving RT and ALT) from meta -analyses of RCTs with suggestive (change to high/low/etc) levels of evidence were identified.

Conclusion: Despite many meta-analyses exploring the associations of lifestyle as well as metabolic syndrome with the risk or treatment of NAFLD, robust clinical RCTs are needed to further investigate the associations between lifestyle modifications and incidence of NAFLD or therapeutic effects on disease progression.

Keywords: Lifestyle; Meta-analyses; Metabolic syndrome; Umbrella review; non-alcoholic fatty liver disease.

Publication types

Review

MeSH terms

Exercise
Humans
Life Style
Metabolic Syndrome* / epidemiology
Metabolic Syndrome* / therapy
Non-alcoholic Fatty Liver Disease* / epidemiology
Non-alcoholic Fatty Liver Disease* / etiology
Non-alcoholic Fatty Liver Disease* / therapy
Randomized Controlled Trials as Topic

Grants and funding

B2019145/the Health Commission Funding Project of Hunan Province, China