A Systematic Review and Meta-analysis on Prevalence of Non-Alcoholic Fatty Liver Disease in Iranian Children: Analysis by BMI, Gender and Grades

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver disorders worldwide, particularly in children. Iranian children are also at risk of developing NAFLD and its complications due to rising obesity and sedentary lifestyles. This study aimed to assess the prevalence of NAFLD among Iranian children based on body mass index (BMI) distribution, gender, and NAFLD grades through a systematic review and meta-analysis.

Methods: The study was designed and conducted following the PRISMA guidelines for article search, validation, selection, data extraction, and reporting. English and Persian language databases were searched up to 1 January 2025. All retrieved articles were evaluated and reviewed. Meta-analysis of the results was performed using CMA software, and findings were reported following the Garrard approach.

Results: Fifteen studies met the inclusion criteria, covering a total of 10,138 Iranian children between 2009 and 2023. The meta-analysis revealed that the overall prevalence of NAFLD in Iranian children was 23.3%. The prevalence based on BMI was 3.9% for children with moderate BMI, 14.4% for overweight children, and 44.1% for obese children. Boys were more affected by NAFLD than girls (35.1% versus 22.4%). The study also showed that 18.3% of children had grade I NAFLD, while 3.8% were diagnosed with grade II.

Conclusion: Fatty liver disease is prevalent among children and is nearly as common as in adults. Diet and reduced physical activity are major risk factors for NAFLD, making their management essential for the prevention and treatment of the condition.