High prevalence of non-alcoholic fatty liver disease in patients with inflammatory bowel disease receiving anti-tumor necrosis factor therapy

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is common in patients with inflammatory bowel disease (IBD). This study evaluated the prevalence of NAFLD and the associated risk factors among IBD patients who received anti-tumor necrosis factor (TNF) therapy.

Methods: Adult IBD patients receiving anti-TNF therapy (infliximab, adalimumab, certolizumab, golimumab) were enrolled. Hepatic steatosis was assessed by abdominal ultrasound. Patients with a history of excessive alcohol or recent steroid use were excluded. Univariate and multivariate analysis were performed.

Results: Eighty patients, 55% male, mean age 42±15 years, were enrolled. The sonographic prevalence of NAFLD was 54% (43/80), significantly higher than the general prevalence in the US adult population (30%) (P<0.0001). NAFLD patients had a significantly higher proportion of males, as well as greater body weight and body mass index, compared to non-NAFLD. The Crohns disease activity index (CDAI) was significantly higher among patients with NAFLD. Multivariate analysis demonstrated that a higher CDAI was independently associated with NAFLD, with an odds ratio of 1.6 (95% confidence interval 1.05-2.44; P=0.03).

Conclusions: The presence of IBD is strongly associated with NAFLD. We identified a high prevalence of NAFLD among IBD patients receiving anti-TNF. CDAI was independently associated with hepatic steatosis. Further studies are still needed to evaluate the pathophysiology of NAFLD development and disease progression among IBD populations.

Keywords: Hepatic steatosis; anti-tumor necrosis factor; inflammatory bowel disease; non-alcoholic fatty liver disease.

Figure 1

Non-alcoholic steatohepatitis Fibrosure in patients with the hepatic steatosis (n=31) Steatosis score; S0=<0.3 (no steatosis), S0-1=0.3-0.4 (minimal steatosis), S1-2=0.48-0.67 (moderate steatosis), S2-3≥0.67 (severe steatosis). Steatohepatitis score; N0=0.25 (no steatohepatitis), N1=0.50 (probable steatohepatitis), N2=0.75 (steatohepatitis). Fibrosis score; F0≤0.21 (no fibrosis), F0-1=0.21-0.30 (portal fibrosis), F1-2=0.31-0.58 (bridging fibrosis with few septa), F3=0.58-0.72 (bridging fibrosis with many septa), F4≥0.72 (cirrhosis)