Global epidemiology of diabetes and prediabetes in lean or non-obese patients with NAFLD: a systematic review and meta-analysis.
Yuan-Yuan Li, Yuan Yu, Hai Bo Jing et al.
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In 30 seconds
This systematic review and random-effects meta-analysis estimated the global prevalence of diabetes and prediabetes among people with lean or non-obese non-alcoholic fatty liver disease (NAFLD). Across 54 studies involving 146,714 patients, pooled prevalence was 15.6% (95% CI 10.8%-22.7%) for diabetes and 22.9% (95% CI 12.5%-41.9%) for prediabetes. Prevalence varied by region: diabetes was highest in South American studies, while prediabetes was highest in European studies. Geographic region and mean age were associated with diabetes prevalence; region and country were associated with prediabetes prevalence.
Key findings
- Pooled diabetes prevalence in lean or non-obese NAFLD was 15.6% (95% CI 10.8%-22.7%).
- Pooled prediabetes prevalence was 22.9% (95% CI 12.5%-41.9%).
- Diabetes prevalence was highest in South American studies at 41.3% (CI 39.1%-43.5%); prediabetes was highest in European studies at 34.4% (CI 23.0%-51.4%).
- Geographic region and mean age jointly accounted for 51.61% of diabetes-prevalence heterogeneity; region and country accounted for 73.65% of prediabetes-prevalence heterogeneity.
Why it matters
The pooled estimates indicate that dysglycaemia is common even among patients with NAFLD who are lean or non-obese. This challenges reliance on obesity as a cue for metabolic risk assessment and supports attention to diabetes and prediabetes in this population. Regional variation and substantial heterogeneity also caution against assuming that a single prevalence estimate applies uniformly across settings.
What to keep in mind
The estimates combine studies with substantial heterogeneity, and prevalence varied by geographic and demographic factors. The abstract does not report study-level quality or explain how differences in populations and methods were addressed.