The Association Between Educational Attainment and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Observational Studies

Objectives: Educational attainment appears to be associated with non-alcoholic fatty liver disease (NAFLD). The inconsistent findings across existing studies necessitate a thorough meta-analysis to elucidate this association. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted from inception to 31 December 2024, without language restrictions. Data were analyzed using Review Manager 5.4, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) estimated via appropriate models. Results: 27 studies involving 446,312 participants (93,116 NAFLD; 353,196 healthy individuals) were included. Noteworthy heterogeneity was detected, with I2 = 96% for more-than-high-school and I2 = 95% for high-school-education when we pooled all the studies together. Further subgroup analyses suggested that higher education was inversely associated with NAFLD risk in some developed countries, like the United States, while potential gender-specific effects were found among the Chinese population. Conclusions: The current meta-analysis suggests that the association between educational attainment and NAFLD is complex and context-dependent, and it may vary across different countries and types of sex.