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Association between nonalcoholic fatty liver disease and reduced bone mineral density in children: A meta-analysis

Association between nonalcoholic fatty liver disease and reduced bone mineral density in children: A meta-analysis
Association between nonalcoholic fatty liver disease and reduced bone mineral density in children: A meta-analysis
Recent cross‐sectional studies have examined the association between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) in children or adolescents, but these have produced conflicting results. We performed a systematic review and meta‐analysis of these published studies to quantify the magnitude of the association, if any, between NAFLD and BMD.

We searched publication databases from January 2000 to September 2018, using predefined keywords to identify relevant observational studies conducted in children or adolescents in which NAFLD was diagnosed either by imaging or by histology, and BMD Z score was measured by dual energy X‐ray absorptiometry. Data from selected studies were extracted, and meta‐analysis was performed using random‐effects modelling. A total of eight observational cross‐sectional or case‐control studies enrolling 632 children and adolescents (mean age: 12.8 years), 357 of whom had NAFLD, were included in the final analysis. Meta‐analysis showed significant differences in whole‐body or lumbar BMD Z scores between children/adolescents with and without NAFLD (n=6 studies; pooled weighted mean difference [WMD]: ‐0.48, 95%CI ‐0.74 to ‐0.21; I2=55.5%), as well as between those with biopsy‐confirmed nonalcoholic steatohepatitis (NASH) and those with no‐NASH (n=4 studies; pooled WMD: ‐0.27, 95%CI ‐0.40 to ‐0.13; I2=0%). The aforementioned WMDs in BMD Z scores were independent of common clinical risk factors, such as age, sex, race/ethnicity and body mass index. Sensitivity analyses did not modify these findings. Funnel plot and Egger test did not reveal significant publication bias. Conclusion: This meta‐analysis shows that the presence and severity of NAFLD is significantly associated with reduced whole‐body BMD Z scores in children and adolescents. However, the observational design of the studies included does not allow for proving causality.
0270-9139
Mantovani, Alessandro
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Gatti, Davide
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Zoppini, Giacomo
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Lippi, Giuseppe
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Bonora, Enzo
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Byrne, Christopher
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Nobili, Valerio
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Targher, Giovanni
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Mantovani, Alessandro
fa13af68-b1c4-404d-b4da-afbad67834bf
Gatti, Davide
f7320bee-575a-45f4-a58b-046ee2342456
Zoppini, Giacomo
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Lippi, Giuseppe
0f4f957b-c8ae-4fb4-b4ae-35228f1bcb93
Bonora, Enzo
9bd2383e-68e5-4eef-a0be-1604dadc31bd
Byrne, Christopher
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Nobili, Valerio
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Targher, Giovanni
426b45b5-398b-4723-9d5a-08a84afe44d7

Mantovani, Alessandro, Gatti, Davide, Zoppini, Giacomo, Lippi, Giuseppe, Bonora, Enzo, Byrne, Christopher, Nobili, Valerio and Targher, Giovanni (2019) Association between nonalcoholic fatty liver disease and reduced bone mineral density in children: A meta-analysis. Hepatology. (doi:10.1002/hep.30538).

Record type: Article

Abstract

Recent cross‐sectional studies have examined the association between nonalcoholic fatty liver disease (NAFLD) and bone mineral density (BMD) in children or adolescents, but these have produced conflicting results. We performed a systematic review and meta‐analysis of these published studies to quantify the magnitude of the association, if any, between NAFLD and BMD.

We searched publication databases from January 2000 to September 2018, using predefined keywords to identify relevant observational studies conducted in children or adolescents in which NAFLD was diagnosed either by imaging or by histology, and BMD Z score was measured by dual energy X‐ray absorptiometry. Data from selected studies were extracted, and meta‐analysis was performed using random‐effects modelling. A total of eight observational cross‐sectional or case‐control studies enrolling 632 children and adolescents (mean age: 12.8 years), 357 of whom had NAFLD, were included in the final analysis. Meta‐analysis showed significant differences in whole‐body or lumbar BMD Z scores between children/adolescents with and without NAFLD (n=6 studies; pooled weighted mean difference [WMD]: ‐0.48, 95%CI ‐0.74 to ‐0.21; I2=55.5%), as well as between those with biopsy‐confirmed nonalcoholic steatohepatitis (NASH) and those with no‐NASH (n=4 studies; pooled WMD: ‐0.27, 95%CI ‐0.40 to ‐0.13; I2=0%). The aforementioned WMDs in BMD Z scores were independent of common clinical risk factors, such as age, sex, race/ethnicity and body mass index. Sensitivity analyses did not modify these findings. Funnel plot and Egger test did not reveal significant publication bias. Conclusion: This meta‐analysis shows that the presence and severity of NAFLD is significantly associated with reduced whole‐body BMD Z scores in children and adolescents. However, the observational design of the studies included does not allow for proving causality.

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NAFLD and BMD in Adolescents_HEP_clean version R1 - Accepted Manuscript
Restricted to Repository staff only until 31 January 2020.
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Accepted/In Press date: 28 January 2019
e-pub ahead of print date: 31 January 2019

Identifiers

Local EPrints ID: 428004
URI: https://eprints.soton.ac.uk/id/eprint/428004
ISSN: 0270-9139
PURE UUID: 8f4f1df0-f839-4926-a025-c717e37d1c17
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 06 Feb 2019 17:30
Last modified: 07 Aug 2019 00:47

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Contributors

Author: Alessandro Mantovani
Author: Davide Gatti
Author: Giacomo Zoppini
Author: Giuseppe Lippi
Author: Enzo Bonora
Author: Valerio Nobili
Author: Giovanni Targher

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