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

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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.

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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).

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Authors and Affiliations



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.

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Correspondence to Qiang She.

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

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Liu, B., Li, Y., Li, Y. et al. Association of epicardial adipose tissue with non-alcoholic fatty liver disease: a meta-analysis. Hepatol Int 13, 757–765 (2019).

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