Systematic Reviews
Copyright ©The Author(s) 2017.
World J Hepatol. Feb 18, 2017; 9(5): 278-287
Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.278
Table 1 Pooled data of vitamin D levels and liver fibrosis from the 12 included studies
YearAuthorCountryDesignnHCV GTHIVDefinition of vitamin D insufficiency (I)/deficiency (D)Outcome (serum vitamin D and liver fibrosis)P value/OR 95%CIGRADE quality of evidence very low = 1, low = 2, moderate = 3, high = 4 and strength of recommendation: 2 = strong 1 = weak
2010PettaItalyProspective1971No< 30 ng/mL for low vitamin D levelLow 25(OH)D associated with severe fibrosis (F3/F4)0.942 [0.893, 0.994] P = 0.009GRADE 3
2011TerrierFranceProspective1891,-4 otherYes< 10 ng/mL D, 10-30 ng/mL (I)Low 25(OH)D correlate with severe fibrosis (F3/F4)P = 0.04GRADE 3
2012LangeSwedenRetrospective4961, 4No< 10 ng/mL D, < 20 ng/mL (I)Advanced fibrosis stage F2-F4 vs F0-F1 associated with low 25(OH)D0.31 [0.12, 0.82] P = 0.018GRADE 2
2012WeintraubUnited StatesCross-sectional1711No< 20 ng/mL or < 30 ng/mL (I)Higher 25(OH)D predictive of milder fibrosis (F0-F2) in white patients but not in African AmericansP = 0.007GRADE 2
2012BaurSwitzerlandCohort2511, 3No< 20 ng/mL (I)(1) 25(OH)D lower in more advanced fibrosis (F2 vs F0-1); (2) low 25-OH vitamin D associated with rapid fibrosis progression rate.P = 0.005,GRADE 3
P = 0.013
2013El-MaoucheUnited StatesProspective116-Yes< 15 ng/mL (D)(1) The prevalence of significant fibrosis (F2 ≥ 2) was similar among those with and without lowP = 0.43GRADE 3
Vitamin D; (2) low 25(OH)D not associated with significant fibrosis after adjusting for other confounders1.37 [0.77, 2.44]
2013MandorferAustriaProspective651, 4Yes< 10 ng/mL D, 10-30 ng/mL (I)Patients withP = 0.009Strong
D-DEF displayed a higher prevalence of advanced liverGRADE 3
2013KitsonAustralia and New ZealandProspective2741No< 50 nmol/L D < 75 nmol/L (I)Fibrosis than patients with D-NORM Baseline 25(OH)D level did not vary with fibrosis stage (F3/4 vs F0-2)P = 0.18Strong
2013AmanzadaGermanyProspective1911Yes< 30 ng/mL (I)Low 25(OH)D associated with advance fibrosis (F0-2 vs F3/4)P = 0.02Strong
2014GerovaBulgariaRetrospective2961, 4No< 25 nmol/L (D), 25-50 nmol/L for profound (I), 50 –80 nmol/L for mild (I)Lower 25OHD levels were registered in cases with advanced fibrosis compared to those with mild or absent fibrosisP >0.05Strong
2014Guzman-FulgencioSpainRetrospective1741, 4Yes< 10 ng/mL (D), 10-30 ng/mL (I)Low 25(OH)D deficiency associated with advanced fibrosis (F3/4 vs F0-2)P = 0.005Weak
2015EsmatEgyptProspective1014No< 20 ng/mL (D), 20-30 (I)No correlation found between vitamin D levels and stage of liver fibrosisP = 0.26Weak
Table 2 Selection criteria for inclusion and exclusion
Inclusion criteria
Age ≥ 18 yr
Studies including mono-infected HCV or co-infected HCV/HIV
Studies that evaluated liver fibrosis stage, only based on liver histology
Studies that reported serum or plasma 25(OH)D levels
Exclusion criteria
Age < 18 yr
Other etiologies of liver disease, other than hepatitis C
Studies that used non-invasive methods in evaluating liver fibrosis
Inadequate data