The relationship between nonalcoholic fatty liver disease and frailty: A systematic review and meta-analysis

BACKGROUND AND AIM: Frailty is frequently observed in end-stage liver disease of various etiologies, but its role in nonalcoholic fatty liver disease (NAFLD) remains incompletely understood. We aimed to conduct a systematic review and meta-analysis to assess the association and prevalence of frailty in NAFLD. METHODS: A systematic review of PubMed/MEDLINE, EMBASE, Web of Science, and Scopus was performed. The random-effects model was used to estimate the pooled prevalence of frailty. Meta-analyzed odds ratios (OR) were calculated to examine the association between frailty and NAFLD. RESULTS: Among the initial 430 articles identified, 18 studies were included. Three studies involving 3673 participants had a pooled OR of 2.03 (95% CI: 1.51-2.72; Iˆ2 = 1.1%; p < 0.0001) for the association between frailty and NAFLD. The pooled prevalence of frailty in individuals with NAFLD was 23% (95% CI: 13%-38%; Iˆ2 = 93.5%) using the liver frailty index (LFI) and 8% (95% CI: 3%-21%; Iˆ2 = 98.1%) using the Fried frailty index (FFI). NAFLD patients' mean grip strength and balance time were 26.4 kg (95% CI: 23.0-29.8) and 23s (95% CI: 10-35), respectively. Among studies that also included individuals with liver cirrhosis, grip strength was lower in those with cirrhosis vs. the broader population of those with NAFLD. CONCLUSIONS: Our study suggests that frailty is highly prevalent in individuals with NAFLD, with a significantly higher prevalence compared to those without NAFLD. Individuals with NAFLD have more than two-fold increased odds of frailty. Assessing frailty in NAFLD patients enables targeted management to improve outcomes.