Abstract
Non-alcoholic fatty liver disease (NAFLD) can be detected in up to 33.6% of inflammatory bowel disease (IBD) patients, often in absence of metabolic risk factors. Nevertheless, most of previous studies on such issue were conducted within the IBD population only. The primary aim of this study was to compare clinical and metabolic features of NAFLD in patients with and without IBD (w/o IBD) and to identify specific NAFLD phenotypes within the IBD population. Among 223 NAFLD patients, 78 patients with IBD were younger compared to 145 without (w/o) IBD, were less likely to have altered liver enzymes, had lower mean body weight, smaller waist circumference and lower body mass index (BMI); at the same time, MetS was more prevalent among patients w/o IBD (56.6 vs. 23.1%, p < 0.001). Within IBD population, patients with severe IBD showed more often severe steatosis (S3) at ultrasound (US) (32.1 vs. 16.6%, p = 0.01), compared to mild-to-moderate disease. Independent risk factors for S3 US steatosis in IBD patients at the multivariate logistic regression analysis were: more than 1 IBD relapse per year during disease history (OR 17.3, 95% CI 3.6–84), surgery for IBD (OR 15.1, 95% CI 3.1–73.7) and more extensive intestinal involvement (OR 19.4, 95% CI 3.4–110.9); the ongoing anti-Tumor Necrosis Factor alpha (antiTNFα) therapy was the only independent factor which protect toward the presence of altered liver enzymes (OR 0.15, 95% CI 0–0.8, p = 0.02). In conclusion, NAFLD in IBD patients is different from that in patients w/o IBD, who seem to develop different NAFLD phenotypes according to intestinal disease clinical course. More severe IBD seem to predict the presence of more severe steatosis. Therapy with antiTNFα antibodies could prevent alteration of liver enzymes in such population.
Highlights
Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of disorders, ranging from hepatic steatosis (NAFL) to non-alcoholic steatohepatitis (NASH)
NAFLD is typically associated with altered metabolism and metabolic syndrome (MetS), it occurs in patients with inflammatory bowel disease (IBD)
In this study, we compared NAFLD phenotype in patients with and without IBD and we identified factors associated, in the IBD population, with the presence of severe steatosis and with increased AST/ALT levels: these are potential determinants for progression of liver condition toward liver fibrosis and cirrhosis[3,4,5,16]
Summary
Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of disorders, ranging from hepatic steatosis (NAFL) to non-alcoholic steatohepatitis (NASH). NAFLD patients are at high risk for liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC)[1,2,3,4,5]. NAFLD is typically associated with altered metabolism and metabolic syndrome (MetS), it occurs in patients with inflammatory bowel disease (IBD). In this context, NAFLD is usually considered the consequence of malnutrition and malabsorption[6]. The prevalence of NAFLD in IBD patients is highly variable ranging from 1.5% to even 40%, in dependence of different diagnostic criteria[7,8,9]. In a recent retrospective study, Bessissow et al.[10] confirmed that NAFLD is often diagnosed in IBD patients (prevalence 33,6%, incidence rate 9.1/100 PY); at baseline, IBD patients who developed
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