High Parathyroid Hormone Levels Linked to NAFLD

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A meta-analysis suggest the correlation between PTH and non-alcoholic fatty liver disease is significant enough for it to be biomarker for disease.

High levels of parathyroid hormone (PTH) is significantly associated with non-alcoholic fatty liver disease (NAFLD), according to new data. In fact, the findings from a multinational team of investigators elucidate high PTH may be a biomarker for NAFLD presence.1

A team of investigators led by Aunchalee Jaroenlapnopparat, MD, of the department of medicine at Mount Auburn Hospital, Beth Israel Lahey Health and Harvard Medical School in Boston, conducted a systematic review and meta-analysis to determine the association between PTH levels and liver diseases including NAFLD and non-alcoholic steatohepatitis (NASH).

They noted that prior studies have implied a potential correlation between the biomarker and prevalence of NAFLD or NASH, though “results from existing studies are inconsistent.”

PTH, associated with the control of phosphorus and vitamin D levels in the body, is a driver of abnormal blood calcium levels depending on its levels. It is measurable in standard blood tests.2

Jaroenlapnopparat and colleagues identified potentially eligible trials for their systematic review and meta-analysis through a pair of public databases, with their search terms including “NASH,” “NAFLD,” and “PTH.” Studies eligible for the analysis included a cohort of NAFLD or NASH patients and a control cohort of healthy participants, as well as measures for mean PTH in both cohorts.

Pooled mean differences were defined for each trial through a random-effects model, and funnel plots helped assess for any publication biases.

The final assessment included 12 of 388 articles that fulfilled eligibility criteria. A meta-analysis of 10 (83.3%) trials showed a significant association between high levels of PTH and NAFLD (pooled mean difference [MD], 5.479; 95% CI, 0.947 – 10.011; I2, 81.0%) without suggestion of publication bias.

A meta-analysis of 4 (33.3%) relevant trials showed the association between high PTH levels and NASH, though, was insignificant (pooled MD, 11.955; 95% CI, -4.703 to 28.614; I2, 81.0%).

“High PTH level is significantly associated with NAFLD and can be used as a marker of NAFLD,” investigators concluded. “However, high PTH level is non-significantly associated with NASH. Further studies are needed to increase the sample size and eliminate the confounding factors.”


  1. Jaroenlapnopparat A, Rittiphairoj T, Chaisidhivej N, Walker B, Charoenngam N. High parathyroid hormone level as a marker of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: A systematic review and meta-analysis [published online ahead of print, 2023 Jul 7]. Diabetes Metab Syndr. 2023;17(8):102827. doi:10.1016/j.dsx.2023.102827
  2. Cleveland Clinic. Web page. Parathyroid Hormone. Updated December 21, 2021.,to%20abnormal%20blood%20calcium%20levels.