NAFLD prevalent in IBD patients

The incidence of nonalcoholic fatty liver disease (NAFLD) is high among individuals with inflammatory bowel disease (IBD), according to data presented at AIBD 2021.

A cross-sectional study was performed using data from a single centre in Brazil. Seventy-one patients were included (mean age 45 years, 64 percent female), 34 of whom had been diagnosed with Crohn’s disease (CD) while 37 had ulcerative colitis (UC). Among patients with CD, half had penetrating behaviour, 42 percent had ileocolonic involvement, and 39 percent had perianal involvement. Among those with UC, about three-quarters (72 percent) had pancolitis. Time from IBD diagnosis was 12.55 years.

While half of the cohort did not present with any other hepatic disorders, ultrasound results reveal that almost half (45 percent) of the cohort had NAFLD, with the majority of the cases being mild-to-moderate (82 percent). [AIBD 2021, abstract P049]

Other disorders reported were choledocholithiasis in two patients, and features of chronic liver disease (ie, irregular surface, bluntness of liver edge, and heterogeneity of hepatic parenchymal echo) in one patient.

There was an increase in portal vein diameter especially among individuals with NAFLD (p<0.021), but no signs of thrombosis were noted in the splanchnic system (ie, portal, splenic, or superior mesenteric veins).

Compared with individuals without NAFLD, those with NAFLD had higher BMI (29.5 vs 24.3; p<0.001) and higher levels of C-reactive protein (1.99 vs 0.87; p=0.006), alanine aminotransferase (24.9 vs 17.9; p=0.009), aspartate aminotransferase (29.7 vs 23.5; p=0.022), fasting glucose (95.5 vs 84.4; p=0.025), and blood insulin (18.4 vs 6.4; p=0.005), all of which are associated with metabolic syndrome. [AIBD 2021, abstract P045]

There were also thrice as many NAFLD patients who had arterial hypertension compared with those who did not have NAFLD (31 percent vs 10 percent; p=0.037).

“Hepatic diseases, such as NAFLD, cirrhosis, cholelithiasis, hepatic thromboembolic events, and primary sclerosing cholangitis are some hepatic complications presented by IBD patients,” said the researchers.

NAFLD has a more complex pathogenesis and is associated with a high cost and hospitalization burden. [Inflamm Bowel Dis 2021;izab199] Given the high prevalence of NAFLD in IBD patients, the researchers highlighted the importance of ultrasonography for early identification and treatment. “Early diagnosis and appropriate nutritional orientation are necessary to prevent NAFLD-related complications.”

The current findings support recommendations in existing literature on IBD and NAFLD. One study noted that IBD care should not be confined to intestinal disease. Instead, it should also encompass evaluation of metabolic factors that could influence the course of IBD. Metabolic interventions should also be considered, including a healthy lifestyle and a diet regimen that could mitigate the co-occurrence of chronic liver diseases and IBD. [World J Gastroenterol 2019;25:5676-5686]

Moreover, it is also imperative to evaluate the impact of therapeutic approaches for IBD on co-existing NAFLD, as well as the impact of NAFLD on IBD treatment, to improve clinical outcomes. [World J Gastroenterol 2016;22:7727-7734]