Study Details Ultrasound Prevalence, Clinical Features of NAFLD in Patients with IBD

Ludovico Abenavoli, MD, PhD

Credit: Academia

Results from a recent study are providing clinicians with an overview of the ultrasound prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD), also calling attention to clinical characteristics associated with IBD-NAFLD.

The cross-sectional observational retrospective study of more than 100 patients with IBD found the ultrasound prevalence of NAFLD was 23%, with results showing greater rates of hypertension and IBD plus dysmetabolic criteria and increased age, BMI, and waist circumference among patients with NAFLD compared to those without.¹

“Liver involvement associated with NAFLD in IBD patients complicates therapeutic management and increases the risk of hospitalization and mortality. Thus, it is essential to adopt an appropriate diagnostic approach aimed at identifying and staging early NAFLD in IBD patients,” wrote Ludovico Abenavoli, MD, PhD, assistant professor of gastroenterology at Magna Graecia University of Catanzaro in Italy, and colleagues.¹

The Crohn’s and Colitis Foundation estimates 25-40% of patients with IBD experience extraintestinal manifestations outside of the gut. Hepatic steatosis is the most common liver complication of IBD and can progress to chronic liver disease.² Ultrasound is frequently used to detect NAFLD in these patients, although its exact prevalence is unknown due to high interindividual variability and merits further examination.¹

To assess the ultrasound prevalence of NAFLD in patients with IBD and the associated clinical features, investigators retrospectively examined demographic, anthropometric, and laboratory data for patients with clinical, endoscopic, and radiological diagnoses of IBD. For inclusion, patients were required to be ≥ 18 years of age and have had a hepatic ultrasound at hospital admission. Patients were excluded from the study if they had a history of drug or alcohol abuse, previous or current viral hepatitis infection, autoimmune liver disease, cirrhosis, malignancies, or were pregnant.¹

In total, 143 patients were enrolled in the study. The majority of participants were male (57%) and the mean age was 45 (Standard deviation [SD], 16) years, the mean BMI was 25 (SD, 4) kg/m2, and the mean waist circumference was 91 (SD, 12) cm. Ulcerative colitis (UC) was prevalent among 91 (63%) participants and Crohn disease (CD) was prevalent among 52 (37%) participants.¹

Investigators collected demographic and anthropometric data, information about disease characteristics, disease location and phenotype, dysmetabolic comorbidities, laboratory parameters, and medications for all participants. In addition to liver evaluation by ultrasound, anamnestic, laboratory, and endoscopic data were also collected and used to divide patients into 2 groups based on the presence or absence of NAFLD.¹

Among the cohort, 33 patients showed hepatic steatosis, including 11 with CD and 22 with UC. Most UC patients showed mild (20%) or severe (2%) liver steatosis, while patients with CD had a greater percentage of moderate liver steatosis (8%). The remaining 110 participants, including 41 with CD and 69 with UC, did not show hepatic steatosis.¹

The ultrasound prevalence of NAFLD was 23%. Investigators pointed out the prevalence was 21% in patients with CD and 24% in patients with UC. Most IBD–NAFLD patients were male (73%). Compared to IBD non-NAFLD patients, patients with NAFLD showed significantly greater values for age (53 years; SD, 13 vs 43 years; SD, 17; P = .03), BMI (27 kg/m2; SD, 5 vs 24 kg/m2; SD, 4; P < .001), and waist circumference (100 cm; SD, 11 vs 88 cm; SD, 11; P < .001).¹

Hypertension and IBD plus dysmetabolic criteria were more prevalent among IBD–NAFLD patients (39% and 78%, respectively) compared to those without NAFLD (10% and 33%, respectively) (P < .001 for both). Investigators also noted a significant difference between the groups for the stenosing phenotype (64% in IBD-NAFLD vs 29% in IBD non-NAFLD; P = .035) and left-side colitis (32% in IBD-NAFLD vs 13% in IBD non-NAFLD; P = .044).¹

Patients in the IBD–NAFLD group showed significantly greater values of alanine aminotransferase (ALT; 22 UI/L; SD, 10 vs 18 UI/L; SD, 9; P = .034) and triglycerides (123 mg/dL; SD, 63 vs 93 mg/dL; SD, 40; P = .002) but significantly lower values of high-density lipoproteins (48 mg/dL; SD, 16 vs 58 mg/dL; SD, 17; P = .005).¹

“Our data suggest the importance of performing [ultrasound] examinations in patients with IBD to detect NAFLD as early as possible. This clinical strategy can be central in improving the management of subjects affected by both these conditions,” concluded investigators.¹

References:

1. Abenavoli L, Spagnuolo R, Scarlata GGM, et al. Ultrasound Prevalence and Clinical Features of Nonalcoholic Fatty Liver Disease in Patients with Inflammatory Bowel Diseases: A Real-Life Cross-Sectional Study. Medicina. 2023; 59(11):1935. https://doi.org/10.3390/medicina59111935
2. Crohn’s and Colitis Foundation. Extraintestinal Complications of IBD. Patients & Caregivers. Accessed November 28, 2023. https://www.crohnscolitisfoundation.org/what-is-ibd/extraintestinal-complications-ibd