Derivation and Internal Validation of a Clinical Prediction Tool to Predict Nonalcoholic Fatty Liver Disease in Patients With Crohn’s Disease

McHenry, Scott; Tirath, Ankita; Tsai, Richard; Sharma, Yeshika; Flores, Avegail; Davidson, Nicholas O.; Fowler, Kathryn J.; Ciorba, Matthew A.; Deepak, Parakkal

doi:10.1093/ibd/izz324

Cited by 12 publications

(24 citation statements)

References 33 publications

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“…Five papers reported the prevalence of NAFLD in patients with CD according to disease location, behaviour or extent 5,31,37,38,53 . Concerning disease location in CD, the highest pooled prevalence related to ileal (28.8%, 95% CI 19.1–38.5; I 2 = 76.4%; p =0.002), followed by upper gastrointestinal (23.7%, 95% CI 10.2–37.2; I 2 =0.0%; p =0.983), ileocolonic (23.0%, 95% CI 11.0–35.0; I 2 = 93.2%; p <0.001), and colonic (18.4%, 95% CI 5.6–31.2; I 2 = 84.3%; p <0.001), and the difference was not statistically significant ( p =0.527) (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…A total of six studies reported the prevalence of advanced liver fibrosis in 1012 IBD patients with NAFLD 6,24,37,39,43,45 . The overall pooled prevalence was 13.6% (95% CI 7.6–19.7; I 2 = 89.7%; p <0.001) (Figure 5).…”

Section: Resultsmentioning

confidence: 99%

“…There were six studies that reported the prevalence of NAFLD according to IBD activity. 5,24,30,35,37,38 The criteria used to stratify the patients according to the disease activity are summarised in Table S4. Overall, the pooled prevalence in subjects with active disease (34.5%, 95% CI 18.8-50.2; I 2 = 95.8%; p <0.001) was very close to that in those with inactive disease (34.2%, 95% CI 27.2-41.2; I 2 = 85.8%; p <0.001), and the difference was not statistically significant (p =0.971) (Table 1).…”

Section: Pooled Prevalence Of Nafld In Patients With Ibd According To...mentioning

confidence: 99%

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Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Zamani

Alizadeh-Tabari

Singh

et al. 2022

Aliment Pharmacol Ther

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Summary Background Non‐alcoholic fatty liver disease (NAFLD) is found in inflammatory bowel disease (IBD). However, uncertainties remain on the magnitude of the association. Aims To explore systematically the prevalence of, and risk factors for, NAFLD in IBD patients. Methods We searched medical literature using Embase, PubMed, Web of Science, Scopus and ProQuest, from inception to September 30, 2021. We included observational studies reporting the prevalence of NAFLD in ≥50 adult patients with IBD. Diagnosis of NAFLD could be based on imaging, histopathology, and/or hepatic steatosis index. Sex, age, body mass index (BMI), diabetes, hypertension, dyslipidemia, prior surgery (bowel resection), corticosteroids, biologics and immunomodulators were assessed as potential risk factors for NAFLD. Results Of 1893 citations, 44 eligible studies were finally included, comprising 14 947 subjects from 18 different countries. Pooled prevalence of NAFLD was 30.7% (95% confidence interval [CI] 26.5–34.9) in patients with IBD worldwide, which varied regionally. No significant difference was observed in the odds ratio (OR) of NAFLD among Crohn’s disease (CD) patients compared with ulcerative colitis (UC) patients (1.16, 95% CI 0.93–1.44). Risk of NAFLD was almost twice as high in patients with IBD as in healthy subjects (OR 1.96, 95% CI 1.13–3.41). Age (adjusted OR 1.03, 95% CI 1.01–1.05) and BMI (adjusted OR 1.27, 95% CI 1.22–1.32) were statistically significantly associated with increased risk of NAFLD. The pooled prevalence of advanced liver fibrosis in IBD patients with NAFLD was 13.6% (95% CI 7.6–19.7) based on six studies. Conclusion Up to one‐third of patients with IBD experienced NAFLD worldwide. The risk of NAFLD was two times higher in IBD patients versus healthy subjects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pooled Prevalence Of Nafld In Patients With Ibd According To...mentioning

confidence: 99%

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Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Zamani

Alizadeh-Tabari

Singh

et al. 2022

Aliment Pharmacol Ther

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“…The prevalence of NAFLD in CD is reported to vary between 8.2-39.5% [5][20][21], depending on the diagnostic tools and criteria applied. And previous studies have proposed several factors associated with the NAFLD, including ethnic, BMI, disease duration [10], anti-TNF-α therapy[21] and etc. However, these studies were mostly conducted in a western population.…”

Section: Discussionmentioning

confidence: 99%

“…McHenry et al pointed out that Crohn's disease patients have more than double the risk of NAFLD compared with the general population after considering traditional risk factors [5]. They also constructed a clinical prediction tool to help screen NAFLD, although they admitted the limitation of race and ethnicity [10].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Non-Alcoholic Liver Disease on MRI Among Patients with Crohn's Disease

Hong

Feng

Shen

et al. 2022

Preprint

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Background: It has been documented that Crohn’s disease patients were prone to develop non-alcoholic liver fatty liver disease with less metabolic factors. Our purpose is to investigate the prevalence, clinical characteristics and possible indicators for NAFLD in a cohort of Chinese patients with Crohn’s disease.Methods: Established Crohn’s disease (CD) patients who underwent magnetic resonance enterography (MRE) at the gastroenterology unit of our hospital were consecutively enrolled between June 2018 to May 2020. The diagnosis of NAFLD was made by magnetic resonance proton density fat fraction (MR-PDFF) maps. Medical records during hospitalization were collected and examined by univariate and multivariate analyses. Then a predictive model was constructed based on logistic regression analysis to evaluate the risk of developing NAFLD.Results: A total of 340 CD subjects were enrolled in this study, 83 (24.4%) suffered from NAFLD. Compared with those without NAFLD, patients with NAFLD showed longer disease duration, higher BMI, more frequent use of corticosteroid and pronouncedly elevated liver function tests. The comparison showed no difference in terms of prolonged anti TNF-α use (>54w). Multivariate analysis demonstrated that BMI, ALT, AST and GGT could independently predict hepatic steatosis.Conclusion: NAFLD is frequent in chronic CD patients, while long term use of anti TNF-α seems to have no impact on the development of NAFLD in this population. The model incorporating duration, serum transaminase and body mass index presented as a clinical nomogram could well predict the risk of NAFLD in patient with CD.

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Nonalcoholic Fatty Liver Disease Is a Risk Factor for Thiopurine Hepatotoxicity in Crohn’s Disease

George

Glover

Alayo

et al. 2023

Crohn's &Amp; Colitis 360

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Background Patients with Crohn’s Disease (CD) are predisposed to nonalcoholic fatty liver disease (NAFLD). CD management often includes thiopurines which can promote hepatotoxicity. We aimed to identify the role of NAFLD on the risk of developing liver injury from thiopurines in CD. Methods In this prospective cohort analysis, CD patients at a single center were recruited 6/2017-5/2018. Patients with alternative liver diseases were excluded. The primary outcome was time to elevation of liver enzymes. Patients underwent MRI with assessment of proton density fat fraction (PDFF) on enrollment, where NAFLD was defined as PDFF > 5.5%. Statistical analysis was performed using a Cox-proportional hazards model. Results Of the 311 CD patients studied, 116 (37%) were treated with thiopurines, 54 (47%) of which were found to have NAFLD. At follow-up, there were 44 total cases of elevated liver enzymes in those treated with thiopurines. Multivariable analysis demonstrated that NAFLD was a predictor of elevated liver enzymes in patients with CD treated with thiopurines (HR 3.0, 95% CI 1.2-7.3, p=0.018) independent of age, BMI, hypertension, and type 2 diabetes. Steatosis severity by PDFF positively correlated with peak alanine aminotransferase (ALT) at follow-up. Kaplan-Meier analysis demonstrated poorer complication-free survival (log-rank 13.1, p<0.001). Conclusions NAFLD at baseline is a risk factor for thiopurine induced hepatotoxicity in patients with CD. The degree of liver fat positively correlated with the degree of ALT elevation. These data suggest that evaluation for hepatic steatosis be considered in patients with liver enzyme elevations with thiopurine therapy.

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Derivation and Internal Validation of a Clinical Prediction Tool to Predict Nonalcoholic Fatty Liver Disease in Patients With Crohn’s Disease

Cited by 12 publications

References 33 publications

Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Prevalence and Predictors of Non-Alcoholic Liver Disease on MRI Among Patients with Crohn's Disease

Nonalcoholic Fatty Liver Disease Is a Risk Factor for Thiopurine Hepatotoxicity in Crohn’s Disease

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