Meta‐analysis: vitamin D and non‐alcoholic fatty liver disease

Summary Background Non‐alcoholic fatty liver disease ( NAFLD ) is a highly prevalent condition. Emerging evidence suggests that vitamin D may play a role in the pathogenesis of NAFLD . Aim To review systematically the association between vitamin D levels, measured as serum 25‐hydroxy vitamin D [25( OH )D], and NAFLD . Methods We used PubMed and EMBASE databases to identify all studies that assessed the association between vitamin D and NAFLD up until 22 April 2013, without language restrictions. We included studies that compared vitamin D levels between NAFLD cases and controls and also those that compared the odds of vitamin D deficiency by NAFLD status. Pooled standardised differences and odds ratios were calculated using an inverse variance method. Results Seventeen cross‐sectional and case–control studies have evaluated the association between vitamin D and NAFLD. NAFLD was diagnosed using biopsy (4 studies), ultrasound or CT (10 studies) and liver enzymes (3 studies). Nine studies provided data for a quantitative meta‐analysis. Compared to controls, NAFLD patients had 0.36 ng/ mL (95% CI: 0.32, 0.40 ng/ mL ) lower levels of 25(OH)D and were 1.26 times more likely to be vitamin D deficient (OR 1.26, 95% CI: 1.17, 1.35). Conclusions NAFLD patients have decreased serum 25( OH )D concentrations, suggesting that vitamin D may play a role in the development of NAFLD . The directionality of this association cannot be determined from cross‐sectional studies. Demonstration of a causal role of hypovitaminosis D in NAFLD development in future studies could have important therapeutic implications.