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Fifty\u2010six studies, published between 2003 and 2019, were finally included, reporting data from 5848 individuals (1634 controls and 4214 NAFLD patients).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher circulating TNF\u2010\u03b1 levels were observed in NAFLD patients than controls (standardized mean difference [SMD] 0.84; 95% confidence interval [95% CI] 0.59\u20131.09), NAFL patients than controls (SMD 0.56; 95% CI 0.27\u20130.85), NASH patients than controls (SMD 0.93; 95% CI 0.64\u20131.22), and NASH than NAFL patients (SMD 0.31; 95% CI 0.16\u20130.46). There were only minimal changes in the comparisons between groups after excluding studies with morbidly obese populations (<jats:italic>n<\/jats:italic>\u00a0=\u00a011), or pediatric\/adolescent populations (<jats:italic>n<\/jats:italic>\u00a0=\u00a06), or other than enzyme\u2010linked immunosorbent assay method of TNF\u2010\u03b1 measurement (<jats:italic>n<\/jats:italic>\u00a0=\u00a08). There was high heterogeneity among studies in all comparisons, which was not essentially affected after sensitivity analyses. The meta\u2010regression analysis revealed that the male ratio was positively associated with TNF\u2010\u03b1 SMD in the comparison between patients with NASH and NAFL (beta\u00a0=\u00a00.809; 95% CI 0.052\u20131.566) and accounted for 36% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.037) of the heterogeneity in this pair of comparison. TNF\u2010\u03b1 SMD was not associated with age, body mass index, and alanine aminotransferase in any pair of comparisons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Circulating TNF\u2010\u03b1 levels were higher in patients with NAFLD compared with controls. Higher levels of circulating TNF\u2010\u03b1 were also associated with the severity of NAFLD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15631","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T13:56:08Z","timestamp":1626875768000},"page":"3002-3014","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Circulating tumor necrosis factor\u2010\u03b1 levels in non\u2010alcoholic fatty liver disease: A systematic review and a meta\u2010analysis"],"prefix":"10.1111","volume":"36","author":[{"given":"Victoria","family":"Potoupni","sequence":"first","affiliation":[{"name":"First Laboratory of Pharmacology, School of Medicine Aristotle University of Thessaloniki  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Georgiadou","sequence":"additional","affiliation":[{"name":"First Laboratory of Pharmacology, School of Medicine Aristotle 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