P786 Non-alcoholic fatty liver disease among patients with inflammatory bowel disease in Qatar: Prevalence and risk factors

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) has been progressively identified in patients with inflammatory bowel disease (IBD) in Qatar. We aim to characterise NAFLD in IBD patients in Qatar and to determine predictors for its severity. Methods A retrospective observational study was conducted on 913 IBD patients in Hamad hospital between January 2008 and December 2017. The prevalence of NAFLD among IBD cases was estimated and associations between two or more qualitative variables were assessed using χ2-test. Quantitative data between two independent groups were analysed using unpaired t-test. Univariate and multivariate logistic regression analysis were applied to determine the predictive values of each predictor for NAFLD among IBD patients. Results Among 913 IBD patients with a mean age of 36.9 ± 13.2 years and BMI 26.9 ± 6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs. 11.9%; p = 0.949). Patients who developed NAFLD were older at baseline, higher BMI and had a higher prevalence of diabetes and hypertension. Age >50 years (OR 3.34; 95% CI 1.82, 6.14; p = 0.001), BMI >30kg/m2 (OR 2.87; 95% CI 1.71, 4.84; p = 0.001), the presence of hypertension (OR 1.98; 95% CI 1.16, 3.38; p = 0.01) and diabetes mellitus (OR 3.05; 95% CI 1.87, 4.95; p = 0.001), were all positive and significantly associated with an increased risk whereas gender female associated with significantly decreased risk for NAFLD (OR 0.63; 95% CI 0.41, 0.98; p = 0.04). Multivariate analysis showed age >40 to 50 years (adjusted OR 2.98; 95% CI 1.62, 5.48; p = 0.001), age >50 years (adjusted OR 2.03; 95% CI 1.03, 4.0; p = 0.04), BMI>30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; p = 0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; p = 0.02) significantly associated with an increased risk of NAFLD whereas gender female showed protective effect and have decreased risk (adjusted OR 0.58; 95% CI 0.36, 0.93; p=0.02). The treatment with biologic does not increase the risk of steatosis and the predicted cut-off NAFLD score of ≥ -1.67 had good predictive ability for significant steatosis. Conclusion The prevalence of NAFLD in IBD patients was 11.8% in Qatar. We did not find an association between the medications used and the progression to NAFLD in IBD patients. Older age, high BMI and diabetes mellitus increase its risk. Non-invasive screening using NAFLD Score could help early diagnosis and initiation of interventions in such patients.

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

“…Of these, 92 articles appeared to be potentially pertinent to the study question and were retrieved for further evaluations. Finally, a total of 44 papers fulfilled the eligibility criteria (Figure 1), comprising 14,947 subjects from 18 different countries worldwide 5–7,13,19–58 . There was an excellent agreement between the two investigators for the eligibility judgement (Kappa statistic =0.85).…”

“…Overall, the pooled prevalence was higher in men with IBD (33.2%, 95% CI 25.5–40.9; I 2 = 96.0%; p <0.001) compared with women (27.0%, 95% CI 20.5–33.4; I 2 = 93.3%; p <0.001) (Table 1). The aOR for NAFLD in men versus women with IBD was 1.50 (95% CI 0.96–2.05) according to four studies, 31,39,54,57 without heterogeneity ( I 2 =0.0%; p =0.856) (Figure 4A). Based on five studies on CD patients, again, the pooled prevalence of NAFLD was higher in men (33.2%, 95% CI 16.5–50.0; I 2 = 96.5%; p <0.001) than in women (29.7%, 95% CI 16.5–50.0; I 2 = 88.6%; p <0.001) (Table 1).…”

“…The pooled prevalence of NAFLD was 34.4% (95% CI 28.0–40.8; I 2 = 96.9%; p <0.001) in 25 studies containing 5223 patients with CD, 5,6,13,21,23–25,30–33,35–40,42,44,46,48,53–55,57 and 28.2% (95% CI 22.0–34.3; I 2 = 95.1%; p <0.001) in 22 studies containing 3101 patients with UC (Table 1 and Figure S2). 5,6,13,20,23–25,30–33,35,36,39,42,44,46,48,50,54,55,57 The pooled OR for NAFLD in patients with CD versus patients with UC was 1.16 (95% CI 0.93–1.44) based on 20 studies, with moderate heterogeneity ( I 2 = 63.9%; p <0.001) but no publication bias (Egger’s test, p =0.65) 5,6,13,23–25,30–33,35,36,39,42,44,46,48,54,55,57 …”

“…There were 11 studies reporting the prevalence of NAFLD in IBD patients according to NAFLD severity 5,19,21,23,26,28,30,35,39,44,57 . The pooled prevalence of mild‐to‐moderate NAFLD was higher than severe NAFLD among patients with IBD (78.7% [95% CI 69.4–88.1] versus 21.3% [95% CI 11.9–30.6]).…”

“…There were 11 studies reporting the prevalence of NAFLD in IBD patients according to NAFLD severity. 5,19,21,23,26,28,30,35,39,44,57 The pooled prevalence of mild-to-moderate NAFLD was higher than severe NAFLD among patients with IBD (78.7% [95% CI 69.4-88.1] versus 21.3% [95% CI 11.9-30.6]). In patients with CD, the pooled prevalence of mild-to-moderate NAFLD was higher than severe NAFLD (69.7% [95% CI 64.4-74.9] versus 30.3% [95% CI 25.1-35.6]).…”