Association between nonalcoholic fatty liver disease and epicardial adipose tissue: A Meta-analysis

Objective To investigate the association between nonalcoholic fatty liver disease( NAFLD) and epicardial adipose tissue( EAT). Methods Databases including PubMed,Embase,Web of Science,Wanfang Data,and CNKI were searched for the articles on the association of thickness and volume of EAT with NAFLD published up to January 1,2019. Stata12. 0 was used to calculate standardized mean difference( SMD) and 95% confidence interval( CI); the I2 test was used to evaluate heterogeneity between studies,and sensitivity analysis and subgroup analysis were used to explore the source of heterogeneity. Results A total of 13 articles were included,with 4672 subjects in total( 2586 subjects in the normal control group and 2086 subjects in the NAFLD group). The NAFLD group had a significant increase in EAT compared with the normal control group( SMD = 0. 58,95% CI: 0. 39-0. 77,P < 0. 001). There were significant differences between the NAFLD group and the normal control group in the thickness and volume of EAT( thickness: SMD = 0. 61,95% CI:0. 40-0. 83,P < 0. 001; volume: SMD = 0. 47,95% CI: 0. 17-0. 76,P = 0. 002). As for the Asian population,compared with the normal control group,the NAFLD group had a significant increase in EAT( SMD = 0. 37,95% CI: 0. 06-0. 68,P = 0. 018); as for the European/American population,compared with the normal control group,the NAFLD group had a significant increase in EAT( SMD = 0. 66,95% CI: 0. 40-0. 92,P < 0. 001). Compared with the normal control group,the NAFLD patients aged ≥50 years had a significant increase in EAT( SMD = 0. 46,95% CI: 0. 31-0. 62,P < 0. 001); there was a significant difference in EAT between the NAFLD patients aged < 50 years and the normal control group( SMD = 0. 72,95% CI: 0. 37-1. 06,P < 0. 001). The NAFLD patients with a body mass index( BMI) of ≥30 kg/m2 had significantly thicker EAT than the normal control group( SMD = 0. 79,95% CI: 0. 43-1. 15,P < 0. 001); the NAFLD patients with a BMI of < 30 kg/m2 also had significantly thicker EAT than the normal control group( SMD = 0. 42,95% CI: 0. 21-0. 62,P < 0. 001). Compared with the normal control group,the NAFLD patients undergoing radiological examination had a significant increase in EAT( SMD = 0. 44,95% CI: 0. 26-0. 63,P < 0. 001); compared with the normal control group,the NAFLD patients undergoing liver biopsy also had a significant increase in EAT( SMD = 1. 05,95% CI: 0. 82-1. 29,P < 0. 001). Publication bias was assessed by funnel plots( symmetric),Begg's test( P = 0. 583),and the Egger's test( P = 0. 126),and the results showed high reliability. Conclusion NAFLD is significantly associated with EAT cardiovascular risk factors,which will help NAFLD patients to establish effective strategies for the prevention and control of cardiovascular events.