Sodium in relation with nonalcoholic fatty liver disease: A systematic review and meta-analysis of observational studies.

Findings on the association of sodium with nonalcoholic fatty liver disease (NAFLD) are conflicting. The present systematic review and meta-analysis study aimed to assess the association between salt or sodium intake or serum sodium levels and NAFLD risk. Relevant articles were identified by searching PubMed, Web of Knowledge, Scopus, Proquest, and Embase databases through May 1, 2021, without language restriction. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using Der-Simonian and Laird method and random-effects meta-analysis. The certainty of the evidence was rated using the GRADE method. Out of 6470 documents, 7 epidemiological/observational (1 cohort, 1 case-control, and 5 cross-sectional) studies on the relationship between dietary salt/sodium intakes and NAFLD risk met our inclusion criteria. The meta-analysis of all studies showed a significant positive association between the highest salt/sodium intake and NALFD risk (OR = 1.60, 95% CI: 1.19-2.15) with a meaningful heterogeneity among studies (I 2  = 96.70%, p -value <.001). The NAFLD risk was greater in the studies with higher quality (OR = 1.81, 95% CI: 1.24-2.65) or using the equation-based methods for NAFLD ascertainment (OR = 2.02, 95% CI: 1.29-3.17) or urinary sodium collection as a sodium intake assessment (OR = 2.48, 95% CI: 1.52-4.06). The overall certainty of the evidence was very low. In conclusion, high sodium intake seems to be related to increased NAFLD risk. Further well-designed studies are needed to clarify this association and shed light on the underlying mechanisms.