Nonalcoholic fatty liver disease in patients with inflammatory bowel disease: Beyond the natural history

Abstract

BACKGROUNDNonalcoholic fatty liver disease (NAFLD) is a frequently reported condition in patients with inflammatory bowel disease (IBD). Both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBD-associated NAFLD.AIMTo evaluate the prevalence of steatosis and liver fibrosis (LF) in a cohort of IBD patients and the identification of metabolic- and IBD-related risk factors for NAFLD and LF.METHODSIBD patients were consecutively enrolled from December 2016 to January 2018. Demographic, anthropometric and biochemical data were collected so as eating habits. Abdominal ultrasound and transient elastography were performed to evaluate the presence of NAFLD and LF respectively.RESULTSA total of 178 consecutive patients were enrolled and included in the analysis (95 Ulcerative colitis, 83 Crohn’s disease). NAFLD was detected by imaging in 72 (40.4%) patients. Comparison between patients with and without NAFLD showed no significant differences in terms of IBD severity, disease duration, location/extension, use of IBD-related medications (i.e., steroids, anti-TNFs, and immunomodulators) and surgery. NAFLD was significantly associated with the presence of metabolic syndrome [MetS; odds ratio (OR): 4.13, P = 0.001] and obesity defined by body mass index (OR: 9.21, P = 0.0002). IBD patients with NAFLD showed higher caloric intake and lipid consumption than those without NAFLD, regardless disease activity. At the multivariate analysis, male sex, advanced age and high lipid consumption were independent risk factors for the development of NAFLD. An increased liver stiffness was detected in 21 patients (16%) and the presence of MetS was the only relevant factor associated to LF (OR: 3.40, P = 0.01).CONCLUSIONIn this study, we demonstrate that risk factors for NAFLD and LF in the IBD population do not differ from those in the general population.

Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases: A cross-sectional and longitudinal analysis

“…All other drug therapies of IBD including corticosteroids were not associated with the course of NAFLD in our patients. Interestingly, in contrast, a study from 2013 identified corticosteroids as potential risk factor for NAFLD[ 10 ], while a more recent study showed no difference of steroid use in NAFLD and non-NAFLD IBD patients[ 25 ].…”

Multidimensional Impact of Mediterranean Diet on IBD Patients

“…The prevalence of NAFLD in IBD has been shown to be around 30%–40%, thus suggesting that IBD patients might be at risk of NAFLD and NAFLD-related complications. 12 , 13 …”

DSS-induced colitis is associated with adipose tissue dysfunction and disrupted hepatic lipid metabolism leading to hepatosteatosis and dyslipidemia in mice

“…NAFLD has been shown to be associated with an elevated level of circulating endotoxin that activates Kupffer cells to produce pro-inflammatory cytokines leading to hepatocyte damage 17 , which could be a result of impaired intestinal barrier function. However, although multiple factors in the pathogenesis of IBD and NAFLD have been proposed to explain high NAFLD prevalence in IBD patients and both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBD-associated NAFLD, the causal relationship between these two disorders is still unclear 18 , 19 .…”