Background
Methods
Search strategy
Inclusion and exclusion criteria
Quality assessment and data extraction
Statistical analysis and data synthesis
Results
Study characteristics
Study | Type of Study | Country | NAFLD patients with normal ALT (n) | Overall patients (n) | Diagnostic methods | NOS score |
---|---|---|---|---|---|---|
Mofrad et al.,200321 | Retrospective | USA | 51 | 386 | Histology | 7 |
Amarapurkar et al.,200422 | Prospective | India | 25 | 81 | Histology | 7 |
Fracanzani et al.,200823 | Retrospective | Italy | 63 | 458 | Histology | 7 |
Uslusoy et al.,200924 | Retrospective | Turkey | 9 | 34 | Histology | 7 |
Wong et al.,200925 | Prospective | HongKong (China) | 38 | 173 | Histology | 7 |
Verma et al.,201326 | Retrospective | USA | 56 | 222 | Histology | 7 |
McPherson et al.,201327 | Retrospective | UK | 70 | 305 | Histology | 7 |
Maximos et al.,201528 | Prospective | USA | 165 | 380 | MRI | 7 |
Umehara et al.,201814 | Cross-sectional | USA | 353 | 1616 | Ultrasonography | NA |
Sheng et al.,201813 | Retrospective | China | 69 | 212 | Ultrasonography | 7 |
Sun et al.,201915 | Cross-sectional | China | 75 | 217 | Histology | NA |
Proportion of NAFLD patients with normal ALT in overall NAFLD patients
Variable | Summarized proportion | 95% CI | I2 | P value | Number of studies |
---|---|---|---|---|---|
Overall estimate | 0.24 | [0.19; 0.30] | 92% | < 0.01 | 11 |
Region | |||||
North America | 0.24 | [0.16; 0.36] | 97% | < 0.01 | 4 |
Asia | 0.30 | [0.25; 0.35] | 52% | 0.05 | 4 |
Europe | 0.19 | [0.14; 0.26] | 72% | < 0.01 | 3 |
Type of study | |||||
Retrospective cohort study | 0.21 | [0.16; 0.28] | 87% | < 0.01 | 6 |
Prospective cohort study | 0.32 | [0.22; 0.43] | 85% | < 0.01 | 3 |
Cross-sectional analysis | 0.27 | [0.19; 0.37] | 85% | < 0.01 | 2 |
Diagnostic method | |||||
Histology | 0.22 | [0.17; 0.28] | 85% | < 0.01 | 8 |
MRI | 0.43 | [0.39; 0.38] | NA | NA | 1 |
Ultrasonography | 0.26 | [0.20; 0.34] | 83% | < 0.01 | 2 |
Group size | |||||
More than 300 | 0.22 | [0.14; 0.31] | 97% | < 0.01 | 5 |
300 or less than 300 | 0.27 | [0.23; 0.33] | 46% | 0.06 | 6 |
Summarized proportion of NASH patients with normal ALT in overall NASH patients
Variable | Summarized proportion | 95% CI | I2 | P value | Number of studies |
---|---|---|---|---|---|
Overall estimate | 0.30 | [0.24;0.37] | 85% | < 0.01 | 6 |
Region | |||||
North America | 0.25 | [0.19;0.33] | 85% | < 0.01 | 3 |
Asia | 0.04 | [0.01;0.24] | NA | NA | 1 |
Europe | 0.19 | [0.11;0.30] | 81% | < 0.01 | 2 |
Type of study | |||||
Retrospective cohort study | 0.21 | [0.15;0.29] | 84% | < 0.01 | 5 |
Prospective cohort study | 0.04 | [0.00;0.21] | NA | NA | 1 |
Diagnostic method | |||||
Histology | 0.17 | [0.12;0.25] | 77% | < 0.01 | 5 |
MRI | 0.30 | [0.25;0.37] | NA | NA | 1 |
Group size | |||||
More than 300 | 0.20 | [0.12;0.32] | 91% | < 0.01 | 3 |
300 or less than 300 | 0.20 | [0.15;0.26] | 0% | 0.11 | 3 |
Characteristics of NAFLD patients and NASH patients with normal ALT value
Characteristics | Number of studies | OR (95% CI) | P value | Heterogeneity | Effects model |
---|---|---|---|---|---|
Gender (male vs. female) | 10 | 0.73 (0.40;1.32) | < 0.01 | 90% | Random |
Diabetes | 6 | 2.30 (1.38;3.82) | < 0.01 | 73% | Random |
Hypertension | 5 | 2.03 (1.47;2.80) | 0.56 | 0% | Fixed |
Metabolic syndrome | 4 | 1.42 (1.01;2.00) | 0.60 | 0% | Fixed |
Steatosis grade(1 vs 2–3) | 3 | 4.30 (2.35;7.87) | 0.10 | 57% | Random |
Lobular inflammation(0–1 vs 2–3) | 2 | 3.35 (1.52;7.34) | 0.36 | 0% | Random |