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Patients with IBD may have increased risk for NAFLD

Inflammatory bowel disease may contribute to the development of non-alcoholic fatty liver disease, as patients with IBD and NAFLD had longer duration of IBD and developed NAFLD with fewer metabolic risk factors compared with patients with NAFLD only, according to results of a recent study.

“Patients with IBD who are also obese, or those with more severe disease activity have a higher inflammatory burden. These individuals may be at higher risk for the development of NAFLD,” Kerri Glassner, DO, from the department of internal medicine at Houston Methodist hospital, and colleagues wrote. “It has been shown that the interaction between the innate immune system and the intestinal microbiota during obesity or autoimmunity can promote chronic liver disease progression.”

Between January 2015 and April 2016, the researchers retrospectively reviewed patients enrolled in the IBD program at Houston Methodist hospital and identified a group of 56 patients with IBD and NAFLD, a group of 56 patients with IBD only and a group of 56 patients with NAFLD only, to compare the risk factors of NAFLD in patients with IBD.

Mean patient age in the IBD with NAFLD group was 45 years, which was significantly higher than the mean patient age of 35 years in the IBD only group (P = .007). Mean patient age in the NAFLD group was 46 years. Duration of IBD was significantly longer among patients with NAFLD (20 vs. 10 years; P = .004). The IBD with NAFLD group was 89% white, the IBD only group was 86% white and the NAFLD only group was 56% white.

Between the IBD with NAFLD group and IBD only group, there were no significant differences in vitamin D levels, hemoglobin levels, inflammatory markers, C-reactive protein levels, use of any type of biological medication, use of corticosteroids or use of immunomodulator medications.

The IBD with NAFLD group, compared with the IBD only group, had more patients with obesity (40% vs. 20%; P = .02), diabetes (16% vs. 2%; P = .01), higher mean BMI (30.4 vs. 25.6; P = .002) and more risk factors for development of metabolic syndrome (14% had 3 or more risk factors vs. 3.5%; P = .04).

Between the IBD with NAFLD group and the NAFLD only group, there were no significant differences in liver enzymes, vitamin D levels, hemoglobin levels or mean BMI.

The NAFLD only group, compared with the IBD with NAFLD group, had more patients with obesity (59% vs. 40%; P = .03), diabetes (40% vs. 16%; P = .0001), hypertension (55% vs. 33%; P = .02) and hyperlipidemia (53% vs. 17.5%; P = .0001).

“As with other conditions of the liver and biliary system, early diagnosis and treatment is important. Patients with [non-alcoholic steatohepatitis] are at increased risk for mortality from cardiovascular disease, all-cause malignancy, and liver-related death,” the researchers wrote. “When abnormal liver function tests or imaging is identified, patients will need to be evaluated for the possibility of NAFLD and risk factor reduction initiated. Currently, further study is needed to identify risk factors in patients with IBD.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.