Abstract
Background/purposeAn increased prevalence of non-alcoholic fatty liver disease (NAFLD) is observed in patients with inflammatory bowel disease (IBD) in Western countries. Both intestinal inflammation and metabolic factors contribute to the pathogenesis of IBD-associated NAFLD. The burden of NAFLD is not clear in the Asian population. This study aimed to evaluate the prevalence of NAFLD and liver fibrosis in a cohort of Taiwanese patients with IBD.MethodsFrom January to December 2019, patients with IBD who underwent ultrasound examination were enrolled. Hepatic steatosis and fibrosis were measured with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) using FibroScan. Patients with a history of excessive alcohol or recent steroid use were excluded. Univariate and multivariate analysis were performed.ResultsA total of 81 consecutive patients were enrolled and included in the analysis (45 with ulcerative colitis, 36 with Crohn’s disease). The median age was 42 years old. The patients were classified in terms of body mass index as normal weight (54.3%), underweight (11.1%), overweight (28.4%), and obese (6.2%). The mean CAP increased to 162.22 dB/m in the underweight group, 210.86 dB/m in the normal weight group, 260.7 dB/m in the overweight group, and 274.0 dB/m in the obese group. NAFLD was observed in 29.6% of the patients, 1.2% of which had significant fibrosis. Increased body mass index (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.1–1.62) and older age at IBD diagnosis (OR: 1.05, 95% CI 1–1.11) was found to be associated with the presence of NAFLD.ConclusionIn this study, the prevalence of NAFLD was lower (29.6%) in IBD patients than in the Western population. Higher BMI and older age were associated with NAFLD in our study.
Highlights
Inflammatory bowel disease (IBD, including ulcerative colitis [UC] and Crohn’s disease [CD]) is a chronic inflammatory disease affecting the gastrointestinal tract that has seen increased incidence and prevalence in Asia in the 21st century [1,2,3,4]
Hepatic steatosis and fibrosis were measured with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) using FibroScan
The CAP value increased with increasing weight and severity of Number of cases Age, year ± SD Gender (Male), n (%) BMI, kg/m2 inflammatory bowel disease (IBD) duration, year Age at disease onset, year Bowel resection, n (%) Weight class
Summary
Inflammatory bowel disease (IBD, including ulcerative colitis [UC] and Crohn’s disease [CD]) is a chronic inflammatory disease affecting the gastrointestinal tract that has seen increased incidence and prevalence in Asia in the 21st century [1,2,3,4]. Non-alcoholic fatty liver disease had been rarely described in patients with IBD [8] before the introduction of modern treatments for the disease. These patients had been traditionally viewed as underweight and/or malnourished due to uncontrolled bowel inflammation. With the advent of more effective therapy, these patients may become more overweight and obese compared with those of the general population [9,10,11] These patients are at increased risk of developing NAFLD [8] and the subsequent risk of developing liver cirrhosis and hepatocellular carcinoma [7], especially those with concurrent use of hepatotoxic agents for IBD. The majority of the study involves reports from Western countries and only one article described the presence of NAFLD in 21.8% of CD patients from Japan [12]
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