Authors Rania Abdulredha Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania Giuseppe Guido Maria Scarlata Department of Health Sciences, University "Magna Graecia", 88100 Catanzaro, Italy Micha Gruber Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania Daniel-Corneliu Leucuta Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania Stefan-Lucian Popa 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania Ludovico Abenavoli Department of Health Sciences, University "Magna Graecia", 88100 Catanzaro, Italy Abdulrahman Ismaiel 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Dan L. Dumitrascu 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania DOI: https://doi.org/10.15403/jgld-6289 Keywords: apolipoprotein, non-alcoholic fatty liver disease, NAFLD, non-alcoholic steatohepatitis, NASH, metabolic dysfunction-associated fatty liver disease, MAFLD, metabolic-dysfunction associated steatotic liver disease, MASLD, type 2 diabetes mellitus, biomarkers Abstract

Background and Aims: Fatty liver disease (FLD) is a prevalent condition linked to metabolic disorders and can progress to severe liver diseases. Alterations in apolipoprotein (Apo) levels may provide valuable insights for diagnosing and managing FLD. This systematic review and meta-analysis evaluates these changes across different FLD phenotypes to evaluate their potential as diagnostic biomarkers.

Methods: We evaluated studies from PubMed, EMBASE, and Scopus using a predefined search string. Predefined inclusion and exclusion criteria were applied, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The main summary outcome was the mean difference (MD) in Apo levels.

Results: Out of 773 initial articles, 55 studies involving 432,328 individuals were included. In NAFLD patients vs. controls, ApoA levels showed a MD of -0.029 (95% CI: -0.133, 0.075), ApoA-I had a MD of -0.064 (95%CI: -0.107, -0.021), and ApoB levels had a MD of 0.098 (95%CI: 0.076, 0.120), while ApoB100 had an MD of 0.042 (95% CI: 0.008, 0.076). For NASH vs. controls, ApoA-I levels had a MD of -0.108 (95% CI: -0.125, -0.091) and ApoB levels had a MD of 0.123 (95% CI: 0.054, 0.193), while ApoB100 had a MD of 0.042 (95% CI: -0.051,0.136). In MAFLD vs. controls, ApoA-I levels had a MD of -0.068 (95% CI: -0.124, -0.012) and ApoB a MD of 0.099 (95% CI: 0.091, 0.107). For diabetic NAFLD vs. T2DM (type 2 diabetes mellitus) without NAFLD, ApoA levels had an MD of 0.028 (95% CI: -0.147, 0.204) and ApoB levels an MD of 0.081 (95% CI: 0.040, 0.122).

Conclusions: In NAFLD patients, ApoA-I levels were lower and ApoB and ApoB100 levels were higher compared to controls, with similar patterns seen in NASH patients, who also had higher ApoB levels than those with simple steatosis. MAFLD patients had elevated ApoB and ApoE levels, while overweight/obese NAFLD patients had higher ApoB levels than controls.

How to Cite

1.

Abdulredha R, Scarlata GGM, Gruber M, Leucuta D-C, Popa S-L, Abenavoli L, Ismaiel A, Dumitrascu DL. Apolipoproteins Levels in Fatty Liver Disease: A Systematic Review and Meta-analysis. JGLD [Internet]. 2025 Sep. 26 [cited 2025 Dec. 4];34(3):350-61. Available from: https://www.jgld.ro/jgld/index.php/jgld/article/view/6289

Issue Section

Systematic Review and Meta-Analysis