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BioMed Research International
Volume 2015 (2015), Article ID 213737, 11 pages
Review Article

Association of Nonalcoholic Fatty Liver Disease with Subclinical Cardiovascular Changes: A Systematic Review and Meta-Analysis

1Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
2Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy
3Department of Pediatrics and Child Neuropsychiatry, Sapienza University of Rome, 00161 Rome, Italy

Received 24 October 2014; Revised 13 February 2015; Accepted 18 February 2015

Academic Editor: Shira Zelber-Sagi

Copyright © 2015 Enea Bonci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide, primarily as a result of the epidemic of obesity. NAFLD is strongly associated with insulin resistance, glucose intolerance, and dyslipidemia and is currently regarded as the liver manifestation of the metabolic syndrome, a highly atherogenic condition even at a very early age. Patients with NAFLD including pediatric subjects have a higher prevalence of subclinical atherosclerosis, as shown by impaired flow-mediated vasodilation, increased carotid artery intima-media thickness, and arterial stiffness, which are independent of obesity and other established risk factors. More recent work has identified NAFLD as a risk factor not only for premature coronary heart disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Thus, we conducted a systematic review and meta-analysis to test the hypothesis that NAFLD is associated with evidence of subclinical cardiac structural and functional abnormalities.