Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7367-7381
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7367
Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases: A cross-sectional and longitudinal analysis
Peter Hoffmann, Victoria Jung, Rouven Behnisch, Annika Gauss
Peter Hoffmann, Victoria Jung, Annika Gauss, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg 69120, Germany
Rouven Behnisch, Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg 69120, Germany
Author contributions: Hoffmann P provided medical data, analyzed the data and drafted the manuscript; Jung V collected the data from medical records and analyzed the data; Gaus A helped with the study design, provided medical data and drafted the manuscript; Behnisch R analyzed the data; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of the University of Heidelberg (protocol number: S-299/2018).
Conflict-of-interest statement: Annika Gauss received travel fees from Abbvie and Janssen, speaker’s fees from Janssen, MSD, Tillotts, and Takeda, and consultation fees from Janssen and AMGEN; Peter Hoffmann received travel fees from Abbvie and Janssen and speaker’s fees from Janssen.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peter Hoffmann, MD, Doctor, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany. peter.hoffmann@med.uni-heidelberg.de
Received: October 12, 2020
Peer-review started: October 12, 2020
First decision: October 27, 2020
Revised: November 3, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: December 14, 2020
Abstract
BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is common in the German population, with an even higher prevalence in inflammatory bowel disease patients.

AIM

To investigate the risk factors for NAFLD in inflammatory bowel disease patients.

METHODS

This monocentric retrospective study with a cross-sectional and a longitudinal part included 694 patients. Inclusion criteria were diagnosed inflammatory bowel disease, age ≥ 18 years, availability of at least one abdominal ultrasound. Patients with infectious or suspected alcoholic fatty liver disease were excluded. NAFLD was defined by increased echogenicity at liver ultrasound. Demographic characteristics, disease activity and medications were analyzed as potential risk factors. Parameters influencing the course of NAFLD were identified by a generalized linear mixed model.

RESULTS

Forty-eight percent of Crohn’s disease (CD) patients and 44% of ulcerative colitis patients suffered from NAFLD. Its occurrence was associated with greater age, hypertension and body mass index (BMI) in both groups, and with higher disease activity and dyslipidemia in CD. 2467 ultrasound results were included in the longitudinal analysis. Risk factors for NAFLD were age, BMI, higher disease activity, bowel resection(s), endoscopic activity and azathioprine use in CD; and BMI and endoscopic activity in ulcerative colitis.

CONCLUSION

NAFLD was highly prevalent in this cohort of German inflammatory bowel disease patients. Its risk increased mainly with rising age and BMI. This analysis provides a rationale for non-invasive liver screening in inflammatory bowel disease patients.

Keywords: Crohn’s disease, Ulcerative colitis, Inflammatory bowel disease, Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, Ultrasound

Core Tip: Nonalcoholic fatty liver disease (NAFLD) has a high prevalence. Aim is to investigate risk factors for NAFLD in inflammatory bowel disease. 48% of Crohn’s disease (CD) and 44% of ulcerative colitis patients suffered from NAFLD. Its occurrence was associated with greater age and body mass index (BMI) in both groups, and with higher disease activity in CD. Risk factors for NAFLD in the longitudinal analysis were age, BMI, higher disease activity, bowel resection(s), endoscopic activity and azathioprine use in CD; and BMI and endoscopic activity in ulcerative colitis.