Hepatology International

, Volume 13, Issue 6, pp 757–765 | Cite as

Association of epicardial adipose tissue with non-alcoholic fatty liver disease: a meta-analysis

  • Bin Liu
  • Yingrui Li
  • Yu Li
  • Yajie Liu
  • Yuling Yan
  • Aoran Luo
  • Hong Ren
  • Qiang SheEmail author
Original Article



Increased epicardial adipose tissue (EAT) has been proposed as a risk factor for non-alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the association of EAT with NAFLD.


The PubMed, EMBASE, and Cochrane databases were systematically reviewed by two independent investigators to identify relevant studies assessing the association of EAT thickness (EAT-t) and volume (EAT-v) with NAFLD. Comparisons between NAFLD subjects and controls were performed with meta-analysis and trial sequential analysis (TSA).


A total of thirteen case–control studies (n = 2260 patients) were included in the final analysis. The EAT was significantly increased in NAFLD patients compared with the controls (EAT, SMD: 0.73, 95% CI 0.51–0.94, p < 0.001; TSA-adjusted 95% CI 0.07–0.18; p < 0.001). When comparing the subgroups of NAFLD, the EAT-t in the severe-hepatic steatosis subgroup was thicker than that in the moderate subgroup (SMD: 1.43, 95% CI 0.15–2.71, p = 0.029). This study indicated that the EAT-t in the F3–4 fibrosis subgroup was thicker than that in the F0–2 fibrosis subgroup (SMD: 0.72, 95% CI 0.30–1.14, p = 0.001). The proportion of hypertension (OR = 1.64, 95% CI = 1.24–2.18, p = 0.001) and atherosclerotic cardiovascular disease (ASCVD) (OR = 1.66, 95% CI = 1.21–2.28, p = 0.002) was higher in the high-EAT-t group compared with the low-EAT-t group in NAFLD patients.


The EAT was increased in the NAFLD subjects compared to the controls. The increase in the EAT was associated with the severity of steatosis, fibrosis and cardiovascular disease in patients with NAFLD. These findings provide new information regarding the development and progression of NAFLD.


Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Epicardial adipose tissue Epicardial fat 


Author contributions

Conceived and designed the experiments: QS and BL. Collected the data: BL, Yingrui L, and Yu L. Analyzed the data: BL, Yuling Y, and Yajie L. Wrote the paper: BL. Revised the paper: BL, Yingrui L, Yuling Y, Aoran L, HR and QS.


This study was funded by the National Natural Science Foundation of China (81770251) and the National Natural Science Foundation of China Youth Science Fund Project (81800254).

Compliance with ethical standards

Conflict of interest

Bin Liu, Yingrui Li, Yu Li, Yajie Liu, Yuling Yan, Aoran Luo, Hong Ren and Qiang She declare that they have no competing interests.

Supplementary material

12072_2019_9972_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)
12072_2019_9972_MOESM2_ESM.doc (66 kb)
Supplementary material 2 (DOC 65 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  • Bin Liu
    • 1
  • Yingrui Li
    • 1
  • Yu Li
    • 1
  • Yajie Liu
    • 1
  • Yuling Yan
    • 1
  • Aoran Luo
    • 2
  • Hong Ren
    • 2
  • Qiang She
    • 1
    Email author
  1. 1.Department of CardiologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
  2. 2.Institute for Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of EducationThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina

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