Lifestyle as well as metabolic syndrome and non-alcoholic fatty liver disease: an umbrella review of evidence from observational studies and randomized controlled trials
Open accessAbstract
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.
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The Mediterranean diet advocates the reduction of sugars and refined carbohydrates, saturated fat, ultra-processed foods, and red and processed meat, which are all related to MASLD risk in observational studies.
“Notably, the Mediterranean diet advocates the reduction of sugars and re fi ned carbohydrates, saturated fat, ultra-processed foods, and red and processed meat, which are all related to MASLD risk in observational studies. 104,284,299 -301”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [300]
The Results (Risk of NAFLD; page unavailable) report observational associations for sugar-sweetened beverages and red meat. They also report no association for refined grains in the included meta-analyses. The cited paper does not establish the claimed associations for saturated fat, ultra-processed foods, or processed meat, or describe Mediterranean-diet recommendations. (LLM, conf=0.89)
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References 99 · Cited by 22
Research works printed but not linked: 3
- [47]Chen YP Lu FB Hu YB Xu LM Zheng MH Hu ED A systematic review and a dose-response meta-analysis of coffee dose and nonalcoholic fatty liver disease Clin Nutr. 2019 38 6 2552 2557 10.1016/j.clnu.2018.11.030 30573353 · DOI · Paper page
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- [66]Fatty liver and Alcoholic Liver Disease Group, Hepatology Branch, Chinese Medical Association, Fatty liver Disease Expert Committee, Chinese Medical Association. Guidelines for the Prevention and treatment of nonalcoholic fatty liver disease (2018). Chin J Liver Dis. 2018;34(5):195–203.
- Authors
- Peng, X., Li, J., Zhao, H., Lai, J., Lin, J., & Tang, S.
- Affiliations
- Liuzhou General Hospital (CN)
- Jinan University (CN)
- Corresponding author
- Tang, Shaohui
- Venue
- BMC Endocrine Disorders
- Published
- 2022-04-10
- Volume
- 22
- Issue
- 1
- Pages
- 95-95
- ISSN
- 1472-6823 (ISSN-L)
- PMC
- PMC8996397
- OpenAlex
- W4223413410
- Cited by
- 22
- References
- 99
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 1
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Endocrine Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- the Health Commission Funding Project of Hunan Province, China (B2019145)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- non-alcoholic fatty liver disease, metabolic syndrome, lifestyle factors, sedentary behavior, dietary habits, green tea, omega-3 polyunsaturated fatty acids, physical activity, NAFLD risk factors, NAFLD treatment
- MeSH terms
- Humans, Life Style, Exercise, Randomized Controlled Trials as Topic, Metabolic Syndrome, Non-alcoholic Fatty Liver Disease
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