Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association between hypertension and nonalcoholic fatty liver disease: a cross-sectional and meta-analysis study

Journal of Human Hypertension volume 37, pages 313–320 (2023)Cite this article

Subjects

Abstract

The association between hypertension and nonalcoholic fatty liver disease (NAFLD) is not completely understood. This study aimed to investigate the association between hypertension and hepatic ultrasound examination-diagnosed positive NAFLD in healthy people; to conduct a comprehensive meta-analysis combining the results of previous studies; to explore whether hypertension was a risk factor for NAFLD. This study included 2049 adults (male: 870 and female: 1179), aged ≥20 years, whose anthropometric parameters were measured to analyze the risk of hypertension on NAFLD. We also collected data from 11 cross-sectional studies relevant to this topic using PubMed, Embase, Web of Science, CNKI, Wanfang, and CQVIP from beginning till 31 August 2020 and combined it with our data for a meta-analysis to explore whether hypertension was a risk factor for NAFLD. After adjusting for confounding factors, the odds of NAFLD in hypertensive subjects was 1.473 (95%CI: 1.119–1.938). After combining with 10 selected studies, 42711 participants were enrolled in meta-analysis. Hypertension was a risk factor for NAFLD (Z = 13.46, P < 0.001); the odds of NAFLD in hypertensive subjects was 1.43 (95%CI: 1.36–1.51). The results were consistent with the results of the meta-analysis. Further studies are required to confirm these results.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart of studies selection.
Fig. 2: Forest plot and sensitivity analysis for hypertension and NAFLD.

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article and its Supplementary Information Files.

References

  1. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313:2263–73.

    Article  CAS  PubMed  Google Scholar 

  2. Zelber-Sagi S, Shoham D, Zvibel I, Abu-Abeid S, Shibolet O, Fishman S. Predictors for advanced fibrosis in morbidly obese non-alcoholic fatty liver patients. World J Hepatol. 2017;9:91–98.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. Lancet Diabetes Endocrinol. 2014;2:901–10.

    Article  PubMed  Google Scholar 

  4. Wainwright P, Byrne CD. Bidirectional relationships and disconnects between NAFLD and features of the metabolic syndrome. Int J Mol Sci. 2016;17:367.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015;47:181–90.

    Article  PubMed  Google Scholar 

  6. Dietrich P, Hellerbrand C. Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Pr Res Clin Gastroenterol. 2014;28:637–53.

    Article  CAS  Google Scholar 

  7. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol. 2008;49:608–12.

    Article  PubMed  Google Scholar 

  8. Lonardo A, Nascimbeni F, Mantovani A, Targher G. Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? J Hepatol. 2018;68:335–52.

    Article  PubMed  Google Scholar 

  9. Donati G, Stagni B, Piscaglia F, Venturoli N, Morselli-Labate AM, Rasciti L, et al. Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance. Gut. 2004;53:1020–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aneni EC, Oni ET, Martin SS, Blaha MJ, Agatston AS, Feldman T, et al. Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk. J Hypertens. 2015;33:1207–14.

    Article  CAS  PubMed  Google Scholar 

  11. The Chinese National Workshop on Fatty Liver and Alcoholic Liver Disease for the Chinese Liver Disease Association. Guidelines for management of nonalcoholic fatty liver disease: an updated and revised edition (Chinese). Chin J Front Med Sci. 2012;4:4–10.

    Google Scholar 

  12. Writing Group of 2018 Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Society of Cardiology, Chinese Medical Doctor Association Hypertension Committee, Hypertension Branch of China International Exchange and Promotive Association for Medical and Health Care, Hypertension Branch of Chinese Geriatric Medical Association. 2018 Chinese guidelines for the management of hypertension (Chinese). Chin J Cardiovasc Med. 2019;24:24–56.

    Google Scholar 

  13. Yongjian Z, Yuqiang N, Yuyuan L, Shengli S. Metabolic syndrome and its relationship with prevalence of nonalcoholic fatty liver disease in a general adult population of Guangdong province (Chinese). Chin J Gastroenterol Hepatol. 2008;17:647–9. https://doi.org/10.3969/j.issn.1006-5709.2008.08.012

    Article  Google Scholar 

  14. Hui S, Youjuan W, Li C, Hong L, Enqiang C, Yuanyuan Z. Analysis of the prevalence of nonalcoholic fatty liver disease and its risk factors (Chinese). Modern Preventive Med. 2009;36:6–8. CNKI:SUN:XDYF.0.2009-01-004

    Google Scholar 

  15. Kirovski G, Schacherer D, Wobser H, Huber H, Niessen C, Beer C, et al. Prevalence of ultrasound-diagnosed non-alcoholic fatty liver disease in a hospital cohort and its association with anthropometric, biochemical and sonographic characteristics. Int J Clin Exp Med. 2010;3:202–10.

    PubMed  PubMed Central  Google Scholar 

  16. He S, Bao W, Shao M, Wang W, Wang C, Sun J, et al. Risk factors for non-alcoholic fatty liver disease in a Chinese population. Acta Gastroenterol Belg. 2011;74:503–8.

    PubMed  Google Scholar 

  17. Otgonsuren M, Stepanova M, Gerber L, Younossi ZM. Anthropometric and clinical factors associated with mortality in subjects with nonalcoholic fatty liver disease. Dig Dis Sci. 2013;58:1132–40.

    Article  CAS  PubMed  Google Scholar 

  18. Wang J, Chiu WH, Chen RC, Chen FL, Tung TH. The clinical investigation of disparity of nonalcoholic fatty liver disease in a Chinese occupational population in Taipei, Taiwan: experience at a teaching hospital. Asia Pac J Public Health. 2015;27:NP1793–NP1804.

    Article  PubMed  Google Scholar 

  19. Ling H, Yu L. The prevalence and metabolic risk factors of nonalcoholic fatty liver disease among middle-aged and aged people (Chinese). J Practical Med. 2017;33:632–5. CNKI:SUN:SYYZ.0.2017-04-036

    Google Scholar 

  20. Hu XY, Li Y, Li LQ, Zheng Y, Lv JH, Huang SC, et al. Risk factors and biomarkers of non-alcoholic fatty liver disease: an observational cross-sectional population survey. BMJ Open 2018;8:e019974.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Han J, Wang Y, Yuan Z, Liu L, Zhao M, Guan Q, et al. Nonalcoholic fatty liver disease represents a greater metabolic burden in patients with atherosclerosis: a cross-sectional study. Medicine. 2019;98:e14896.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Younossi ZM, Stepanova M, Younossi Y, Golabi P, Mishra A, Rafiq N, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2020;69:564–8.

    Article  PubMed  Google Scholar 

  23. Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17:510–9.

    Article  CAS  PubMed  Google Scholar 

  24. Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:739–52.

    Article  PubMed  Google Scholar 

  25. Panza JA. High-normal blood pressure-more “high” than “normal”. N Engl J Med. 2001;345:1337–40.

    Article  CAS  PubMed  Google Scholar 

  26. Ciardullo S, Grassi G, Mancia G, Perseghin G Nonalcoholic fatty liver disease and risk of incident hypertension: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2021. https://doi.org/10.1097/MEG.0000000000002299

  27. Sung KC, Wild SH, Byrne CD. Development of new fatty liver, or resolution of existing fatty liver, over five years of follow-up, and risk of incident hypertension. J Hepatol. 2014;60:1040–5.

    Article  PubMed  Google Scholar 

  28. Liu P, Tang Y, Guo X, Zhu X, He M, Yuan J, et al. Bidirectional association between nonalcoholic fatty liver disease and hypertension from the Dongfeng-Tongji cohort study. J Am Soc Hypertens 2018;12(9):660–70.

    Article  PubMed  Google Scholar 

  29. Zhang T, Zhang C, Zhang Y, Tang F, Li H, Zhang Q, et al. Metabolic syndrome and its components as predictors of nonalcoholic fatty liver disease in a northern urban Han Chinese population: a prospective cohort study. Atherosclerosis. 2015;240:144–8.

    Article  CAS  PubMed  Google Scholar 

  30. Junmei Y, Li Z, Lingyan J, Rui Z, Zhenshan J. Case-control study on the risk factors of nonalcoholic fatty liver disease based on physical examination people in hospital (Chinese). Chin J Prev Contr Chron Dis. 2011;19:551–3. https://doi.org/10.16386/j.cjpccd.issn.1004-6194.2011.06.021

    Article  Google Scholar 

  31. Wu SJ, Zou H, Zhu GQ, Wang LR, Zhang Q, Shi KQ, et al. Increased levels of systolic blood pressure within the normal range are associated with significantly elevated risks of nonalcoholic fatty liver disease. Medicine. 2015;94:e842.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Brookes MJ, Cooper BT. Hypertension and fatty liver: guilty by association? J Hum Hypertens. 2007;21:264–70.

    Article  CAS  PubMed  Google Scholar 

  33. Xukai W, Peng C. Is insulin resistance a cause or a consequence of hypertension? (Chinese). Chin J Hypertens. 2020;28:302–7. https://doi.org/10.16439/j.cnki.1673-7245.2020.04.002

    Article  Google Scholar 

  34. Tarantino G, Conca P, Pasanisi F, Ariello M, Mastrolia M, Arena A, et al. Could inflammatory markers help diagnose nonalcoholic steatohepatitis? Eur J Gastroenterol Hepatol. 2009;21:504–11.

    Article  CAS  PubMed  Google Scholar 

  35. Soleimani M. Insulin resistance and hypertension: new insights. Kidney Int. 2015;87:497–9.

    Article  PubMed  Google Scholar 

  36. Kim DH, Kim C, Ding EL, Townsend MK, Lipsitz LA. Adiponectin levels and the risk of hypertension: a systematic review and meta-analysis. Hypertension. 2013;62:27–32.

    Article  CAS  PubMed  Google Scholar 

  37. Finelli C, Tarantino G. What is the role of adiponectin in obesity related non-alcoholic fatty liver disease? World J Gastroenterol. 2013;19:802–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Singh S, Allen AM, Wang Z, Prokop LJ, Murad MH, Loomba R. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015;13:643–e40.

    Article  PubMed  Google Scholar 

  39. Ciardullo S, Monti T, Sala I, Grassi G, Mancia G, Perseghin G. Nonalcoholic fatty liver disease and advanced fibrosis in US adults across blood pressure categories. Hypertension. 2020;76:562–8.

    Article  CAS  PubMed  Google Scholar 

  40. Kanwal F, Kramer JR, Li L, Dai J, Natarajan Y, Yu X, et al. Effect of metabolic traits on the risk of cirrhosis and hepatocellular cancer in nonalcoholic fatty liver disease. Hepatology. 2020;71:808–19.

    Article  PubMed  Google Scholar 

  41. Sorrentino P, Terracciano L, D’Angelo S, Ferbo U, Bracigliano A, Vecchione R. Predicting fibrosis worsening in obese patients with NASH through parenchymal fibronectin, HOMA-IR, and hypertension. Am J Gastroenterol. 2010;105:336–44.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81660562).

Author information

Author notes

  1. These authors contributed equally: Qingzhi Huang, Hana Yu.

Authors and Affiliations

  1. Department of Preventive Medicine, Medical College, Yanbian University, 977 Gongyuan Street, Yanji, 133000, Jilin, China

    Qingzhi Huang, Hana Yu, Xin Zhong, Ying Tian & Zhenyu Quan

  2. Department of Nephrology, Yanbian University Hospital, 119 Juzi Street, Yanji, 133000, Jilin, China

    Zhenhua Cui

Authors
  1. Qingzhi Huang
    View author publications

    Search author on:PubMed Google Scholar

  2. Hana Yu
    View author publications

    Search author on:PubMed Google Scholar

  3. Xin Zhong
    View author publications

    Search author on:PubMed Google Scholar

  4. Ying Tian
    View author publications

    Search author on:PubMed Google Scholar

  5. Zhenhua Cui
    View author publications

    Search author on:PubMed Google Scholar

  6. Zhenyu Quan
    View author publications

    Search author on:PubMed Google Scholar

Contributions

QH and HY conceived and coordinated the study, collected data, performed data analysis and drafted the manuscript; QH and ZC contributed to selected studies and statistical analysis; XZ, YT, and ZQ reviewed and edited the manuscript; All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zhenyu Quan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, Q., Yu, H., Zhong, X. et al. Association between hypertension and nonalcoholic fatty liver disease: a cross-sectional and meta-analysis study. J Hum Hypertens 37, 313–320 (2023). https://doi.org/10.1038/s41371-022-00686-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41371-022-00686-w

This article is cited by

Search

Advanced search

Quick links