Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.142
Peer-review started: November 8, 2017
First decision: December 4, 2017
Revised: December 12, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: January 27, 2018
To investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and fibrosis stage in patients with non-alcoholic fatty liver disease (NAFLD).
Two individual reviewers identified relevant studies using the PubMed, EMBASE, Cochrane, and Scopus databases. Inclusion criteria were as follows: (1) Studies that evaluated adults with NAFLD and serum or plasma 25(OH)D levels; and (2) assessed fibrosis stage using liver biopsy. A rigorous analysis yielded six articles as having sufficient data to employ in evaluating the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. To meta-analyze vitamin D levels in F0-F2 vs F3-F4 fibrosis, a random-effects meta-analysis fit using restricted maximum likelihood was applied. To examine trends across each stage of fibrosis with respect to vitamin D levels, a meta-regression was performed. P < 0.05 was considered statistically significant.
A total of 937 subjects from six studies were included in the final analysis to evaluate the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. First, the investigators performed a meta-analysis to compare serum vitamin D levels in patients with NAFLD with stage F0-F2 compared to F3-F4, which did not show significance [meta-estimate of the pooled mean difference = -0.86, P = 0.08 (-4.17, 2.46)]. A meta-regression evaluation of serum vitamin 25 (OH)D levels across the individual stages (F0-F4) of fibrosis did not show an association for the six included studies.
Low vitamin D status is not associated with higher stages of liver fibrosis in patients with NAFLD.
Core tip: Non-alcoholic fatty liver disease (NAFLD) is a condition that can progress to cirrhosis, hepatic failure, and liver cancer. Vitamin D sufficiency is impaired in the advanced stages of liver disease and in NAFLD. However, our systematic review of the literature and meta-regression confirms that the serum 25-hydroxyvitamin D levels in patients with NAFLD are not associated with the severity of hepatic fibrosis.