Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: a systematic review and meta-analysis

Abstract Metabolic dysfunction-associated fatty liver (MAFLD) and type 2 diabetes (T2D) are interconnected metabolic disorders that pose serious repercussions on health, yet a comprehensive understanding of the extent of their co-occurrence in Africa is lacking. This study aimed to determine the prevalence of MAFLD and its association with glycemic control (HbA1c) in persons with T2D in Africa. A systematic search was conducted on PubMed, Medline, Embase, Scopus, Global Health, and Web of Science from their inception to December 6, 2023. Data on MAFLD prevalence and correlation coefficients for the association with glycemic control were pooled in random effect meta-analyses. Potential sources of heterogeneity were investigated using subgroup analysis and meta-regression. A total of 10 studies were included in the meta-analysis of MAFLD prevalence, while 2 incorporated in the analysis of the association between MAFLD and glycemic control. The pooled prevalence of MAFLD in persons with T2D was 48.1% (95% CI: 36.1–60.3). By region, the prevalence recorded were 44.7% (95% CI: 28.7–62.0) in sub-Saharan Africa and 55.3% (95% CI: 36.2–73.0) in Northern Africa. We observe an increasing trend in MAFLD prevalence, recording 55.1% (95% CI: 43.6– 66.1) in the recent five years. There was a weak positive correlation between MAFLD and HbA1c (r = 0.33, 95% CI: 0.18 – 0.47). There is a high prevalence of MAFLD in persons with T2D in Africa, with a suggested link between MAFLD and suboptimal glycemic control.