Non-alcoholic Fatty Liver Disease/Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Incident Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis of Cohort Studies
8 affiliations
- 1Medicine, St. Martinus University, Willemstad, CUW
- 2Medicine, Dow University of Health Sciences, Karachi, PAK
- 3Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, IND
- 4Internal Medicine, Avalon University School of Medicine, Beckley, USA
- 5Internal Medicine, Nove de Julho University, Sao Paulo, BRA
- 6Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, USA
- 7Pediatrics, Dow University of Health Sciences, Karachi, PAK
- 8Internal Medicine, University of Health Sciences, Lahore, PAK
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD), has been inconsistently linked to incident atrial fibrillation (AF) across observational cohorts. We performed an updated systematic review and meta-analysis of cohort studies, following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, searching PubMed/MEDLINE, Embase, Scopus, and Web of Science through July 25, 2026, for studies comparing incident AF risk in adults with versus without NAFLD/MASLD. Adjusted effect estimates were pooled using a random-effects model, with heterogeneity assessed via the I² statistic and explored through subgroup and univariable meta-regression analyses. Eighteen cohort studies comprising over 15 million participants from Asia, Europe, and North America met inclusion criteria. Pooling all studies demonstrated a significantly increased risk of incident AF among individuals with NAFLD/MASLD compared with those without (pooled risk ratio (RR) 1.23, 95% confidence interval (CI) 1.12-1.34, p < 0.001), with substantial statistical heterogeneity (I² = 99.4%). In an exploratory analysis of three studies, advanced disease with hepatic fibrosis was also associated with increased AF risk (RR 1.19, 95% CI 1.11-1.28). In the present meta-analysis, NAFLD/MASLD was associated with a modestly higher risk of incident AF after adjustment for conventional cardiometabolic risk factors, although heterogeneity was very high. These findings support attention to AF risk in this population and the use of standardized diagnostic approaches in future research.
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BibTeX
@article{disha2026nonalcoholic,
title = {{Non-alcoholic Fatty Liver Disease/Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Incident Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis of Cohort Studies}},
author = {Disha Disha and Allah Rakhio Bhurgri and Deepak Verma and Steve Amirtharaj and Julia Rinaldi Perico and Sandipkumar S Chaudhari and Hijazi Mallick and Neelum Ali},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117112},
url = {https://europepmc.org/article/PMC/PMC13718993},
note = {CC BY},
}
RIS
TY - JOUR
TI - Non-alcoholic Fatty Liver Disease/Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Incident Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis of Cohort Studies
AU - Disha Disha
AU - Allah Rakhio Bhurgri
AU - Deepak Verma
AU - Steve Amirtharaj
AU - Julia Rinaldi Perico
AU - Sandipkumar S Chaudhari
AU - Hijazi Mallick
AU - Neelum Ali
PY - 2026
DA - 2026/09/28
JO - Cureus
DO - 10.7759/cureus.117112
UR - https://europepmc.org/article/PMC/PMC13718993
AB - Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD), has been inconsistently linked to incident atrial fibrillation (AF) across observational cohorts. We performed an updated systematic review and meta-analysis of cohort studies, following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, searching PubMed/MEDLINE, Embase, Scopus, and Web of Science through July 25, 2026, for studies comparing incident AF risk in adults with versus without NAFLD/MASLD. Adjusted effect estimates were pooled using a random-effects model, with heterogeneity assessed via the I² statistic and explored through subgroup and univariable meta-regression analyses. Eighteen cohort studies comprising over 15 million participants from Asia, Europe, and North America met inclusion criteria. Pooling all studies demonstrated a significantly increased risk of incident AF among individuals with NAFLD/MASLD compared with those without (pooled risk ratio (RR) 1.23, 95% confidence interval (CI) 1.12-1.34, p < 0.001), with substantial statistical heterogeneity (I² = 99.4%). In an exploratory analysis of three studies, advanced disease with hepatic fibrosis was also associated with increased AF risk (RR 1.19, 95% CI 1.11-1.28). In the present meta-analysis, NAFLD/MASLD was associated with a modestly higher risk of incident AF after adjustment for conventional cardiometabolic risk factors, although heterogeneity was very high. These findings support attention to AF risk in this population and the use of standardized diagnostic approaches in future research.
SN - 2168-8184
ER -