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Increased arterial stiffness in nonalcoholic fatty liver disease: a systematic review and meta-analysis

Jaruvongvanich, Veeravicha,d; Chenbhanich, Jiratb,d; Sanguankeo, Anawinc,e; Rattanawong, Pattaraa; Wijarnpreecha, Karnc; Upala, Sikarinc,e

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p e28–e35
doi: 10.1097/MEG.0000000000000909
Original Articles: Hepatitis

Background Arterial function is a marker of early atherosclerotic changes and cardiovascular disease. Several studies have suggested the possible association between nonalcoholic fatty liver disease (NAFLD) and increased arterial stiffness. Thus, we conducted a systematic review and meta-analysis to better characterize this association.

Patients and methods A comprehensive search of the databases of the MEDLINE and EMBASE was carried out from inception through September 2016. All observational studies that compared arterial stiffness between NAFLD patients and healthy controls were included. Arterial stiffness was measured by pulse wave velocity (PWV) and augmentation index. We calculated pooled mean difference (MD) with 95% confidence intervals (CIs) using the random-effects model.

Results Data were extracted from 12 studies involving 9351 NAFLD patients and 17 684 controls. NAFLD is significantly associated with increased arterial stiffness as determined by carotid–femoral PWV (MD=0.75 m/s, 95% CI: 0.43–1.07, I 2=88%), brachial–ankle PWV (MD=0.82 m/s, 95% CI: 0.57–1.07, I 2=92%), and augmentation index (pooled MD=2.54%, 95% CI: 0.07–5.01, I 2=73%) compared with healthy controls.

Conclusion In conclusion, our study demonstrated a higher degree of arterial stiffness in NAFLD patients compared with controls. However, this association might be related to the higher prevalence of cardiometabolic risk factors in NAFLD patients. Further studies are needed to determine an independent association between NAFLD and arterial stiffness adjusting to cardiometabolic risks.

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aDepartment of Internal Medicine, University of Hawaii, Honolulu, Hawaii

bDepartment of Internal Medicine, Metrowest Medical Center, Framingham, Massachusetts

cDepartment of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York, USA

dDepartment of Medicine, King Chulalongkorn Memorial Hospital, Bangkok

eDepartment of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Correspondence to Anawin Sanguankeo, MD, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand Tel: +66 808 542 1939; fax: +66 607 547 6612; e-mail:

Received February 8, 2017

Accepted April 26, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.