Non-alcoholic fatty liver disease and coexisting depression, anxiety and/or stress in adults: a systematic review and meta-analysis

Sue Shea, Christos Lionis, Chris Kite, Lukasz Lagojda, Olalekan A. Uthman, Alexander Dallaway, Lou Atkinson, Surinderjeet S. Chaggar, Harpal S. Randeva*, Ioannis Kyrou*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, affecting 25-30% of the general population globally. The condition is even more prevalent in individuals with obesity and is frequently linked to the metabolic syndrome. Given the known associations between the metabolic syndrome and common mental health issues, it is likely that such a relationship also exists between NAFLD and mental health problems. However, studies in this field remain limited. Accordingly, the aim of this systematic review and meta-analysis was to explore the prevalence of one or more common mental health conditions (i.e., depression, anxiety, and/or stress) in adults with NAFLD. Methods: PubMed, EBSCOhost, ProQuest, Ovid, Web of Science, and Scopus were searched in order to identify studies reporting the prevalence of depression, anxiety, and/or stress among adults with NAFLD. A random-effects model was utilized to calculate the pooled prevalence and confidence intervals for depression, anxiety and stress. Results: In total, 31 studies were eligible for inclusion, involving 2,126,593 adults with NAFLD. Meta-analyses yielded a pooled prevalence of 26.3% (95% CI: 19.2 to 34) for depression, 37.2% (95% CI: 21.6 to 54.3%) for anxiety, and 51.4% (95% CI: 5.5 to 95.8%) for stress among adults with NAFLD. Conclusion: The present findings suggest a high prevalence of mental health morbidity among adults with NAFLD. Given the related public health impact, this finding should prompt further research to investigate such associations and elucidate potential associations between NAFLD and mental health morbidity, exploring potential shared underlying pathophysiologic mechanisms. Systematic review registration:, identifier CRD42021288934.
Original languageEnglish
Article number1357664
Number of pages16
JournalFrontiers in Endocrinology
Early online date16 Apr 2024
Publication statusPublished - 16 Apr 2024

Bibliographical note

Copyright © 2024 Shea, Lionis, Kite, Lagojda, Uthman, Dallaway, Atkinson, Chaggar, Randeva and Kyrou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

Data Access Statement

The Supplementary Material for this article can be found online at:


  • non-alcoholic fatty liver disease
  • depression
  • stress
  • NASH
  • mental health
  • anxiety


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