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The relationship between nonalcoholic fatty liver disease and frailty: A systematic review and meta-analysis
Shaghayegh Khanmohammadi1, Mahdi Masrour2, Parisa Fallahtafti3
1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Background And Aim:
Frailty is frequently observed in end-stage liver disease of various etiologies, but its role in nonalcoholic fatty liver disease (NAFLD) remains incompletely understood. We aimed to conduct a systematic review and meta-analysis to assess the association and prevalence of frailty in NAFLD.
Methods:
A systematic review of PubMed/MEDLINE, EMBASE, Web of Science, and Scopus was performed. The random-effects model was used to estimate the pooled prevalence of frailty. Meta-analyzed odds ratios (OR) were calculated to examine the association between frailty and NAFLD.
Results:
Among the initial 430 articles identified, 18 studies were included. Three studies involving 3673 participants had a pooled OR of 2.03 (95% CI: 1.51-2.72; Iˆ2 = 1.1%; p < 0.0001) for the association between frailty and NAFLD. The pooled prevalence of frailty in individuals with NAFLD was 23% (95% CI: 13%-38%; Iˆ2 = 93.5%) using the liver frailty index (LFI) and 8% (95% CI: 3%-21%; Iˆ2 = 98.1%) using the Fried frailty index (FFI). NAFLD patients' mean grip strength and balance time were 26.4 kg (95% CI: 23.0-29.8) and 23s (95% CI: 10-35), respectively. Among studies that also included individuals with liver cirrhosis, grip strength was lower in those with cirrhosis vs. the broader population of those with NAFLD.
Conclusions:
Our study suggests that frailty is highly prevalent in individuals with NAFLD, with a significantly higher prevalence compared to those without NAFLD. Individuals with NAFLD have more than two-fold increased odds of frailty. Assessing frailty in NAFLD patients enables targeted management to improve outcomes.
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