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:
Corresponding author: Peter Hoffmann, MD, Doctor, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
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
Research background

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

Research motivation

Finding reasons for the high prevalence of NAFLD in inflammatory bowel disease patients.

Research objectives

Identifying risk factors for NAFLD in inflammatory bowel disease patients.

Research methods

Analysis of abdominal ultrasound examinations of inflammatory bowel disease patients and electronically available data was performed. Demographic characteristics, disease activity and medications were analyzed as potential risk factors in a cross-sectional design. Parameters influencing the course of NAFLD were identified by a generalized linear mixed model.

Research 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.

Research conclusions

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

Research perspectives

A randomized controlled prospective study is required to further verify the discovered risk factors.