Risk of non‐alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta‐analysis

Abstract

Background Psoriasis has been linked to an increased risk of metabolic syndrome (MetS). Non‐alcoholic fatty liver disease (NAFLD), the hepatic manifestation of MetS, is now the commonest liver disease worldwide and can evolve into cirrhosis in a subgroup of patients. Psoriasis has been reported to be associated to NAFLD. Aim The aim of this study was to evaluate the strength of the association between psoriasis and NAFLD. Methods A systematic review of the literature was conducted in six databases (Medline, CINAHL, Scopus, LILACS, Cochrane Library and EMBASE). Data from studies assessing frequency of NAFLD in psoriatic and non‐psoriatic patients were extracted and meta‐analysed using the Mantel–Haenszel method. Subgroups analysis of patients with psoriatic arthritis and moderate to severe psoriasis was also performed. Results Seven case–control studies were included, all of them of low or moderate quality. Psoriatic patients exhibited an increased risk of NAFLD compared to non‐psoriatic controls (six studies; n = 267 761 patients; odds ratio (OR): 2.15, 95% CI: 1.57–2.94). The association remained significant (OR: 2.07, 95% CI: 1.62–2.64) when only high/moderate quality studies were analysed (three studies; n = 3345 patients). The risk of NAFLD was significantly greater in patients with psoriatic arthritis (three studies; n = 505 patients; OR: 2.25, 95% IC: 1.37–3.71) and in patients with moderate to severe psoriasis compared to those with mild psoriasis (two studies; 51 930 patients, OR: 2.07, 95% CI: 1.59–2.71). Limitations Data quality and heterogeneity may restrict the interpretation of the pooled risk estimates. Conclusion Case–control studies support an association between psoriasis and NAFLD. Screening of NAFLD in this group of patients may be warranted.