Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5676
Peer-review started: June 13, 2019
First decision: July 21, 2019
Revised: July 30, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: October 7, 2019
Processing time: 109 Days and 6.8 Hours
Nonalcoholic fatty liver disease (NAFLD) is a frequently reported condition in patients with inflammatory bowel disease (IBD). Both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBD-associated NAFLD.
To evaluate the prevalence of steatosis and liver fibrosis (LF) in a cohort of IBD patients and the identification of metabolic- and IBD-related risk factors for NAFLD and LF.
IBD patients were consecutively enrolled from December 2016 to January 2018. Demographic, anthropometric and biochemical data were collected so as eating habits. Abdominal ultrasound and transient elastography were performed to evaluate the presence of NAFLD and LF respectively.
A total of 178 consecutive patients were enrolled and included in the analysis (95 Ulcerative colitis, 83 Crohn’s disease). NAFLD was detected by imaging in 72 (40.4%) patients. Comparison between patients with and without NAFLD showed no significant differences in terms of IBD severity, disease duration, location/extension, use of IBD-related medications (i.e., steroids, anti-TNFs, and immunomodulators) and surgery. NAFLD was significantly associated with the presence of metabolic syndrome [MetS; odds ratio (OR): 4.13, P = 0.001] and obesity defined by body mass index (OR: 9.21, P = 0.0002). IBD patients with NAFLD showed higher caloric intake and lipid consumption than those without NAFLD, regardless disease activity. At the multivariate analysis, male sex, advanced age and high lipid consumption were independent risk factors for the development of NAFLD. An increased liver stiffness was detected in 21 patients (16%) and the presence of MetS was the only relevant factor associated to LF (OR: 3.40, P = 0.01).
In this study, we demonstrate that risk factors for NAFLD and LF in the IBD population do not differ from those in the general population.
Core tip: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, frequently reported in patients with inflammatory bowel disease (IBD). The underlining causes and predisposing factors to NAFLD among IBD patients remain poorly investigated. We performed an observational study enrolling consecutive IBD patients to evaluate the prevalence of steatosis and liver fibrosis and their association with IBD-related risk factors. Our study confirms the epidemiological burden of NAFLD in IBD and demonstrates the absence of intestinal disease-specific risk factors associated to NAFLD, while confirming as risk factors those already identified in the general population. IBD care should not be limited to intestinal disease but should also include metabolic interventions by promoting healthy lifestyle and a correct dietary regimen in order to reduce the occurrence of chronic liver disease.