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Nonalcoholic fatty liver disease in patients with inflammatory bowel disease: Beyond the natural history

World Journal of Gastroenterology 2019年第37期25卷 5676-5686页

作者： Salvatore Magrì Danilo Paduano Fabio Chicco Arianna Cingolani Cristiana Farris Giovanna Delogu francesca tumbarello Mariantonia Lai Alessandro Melis Laura Casula Massimo C Fantini Paolo Usai Department of Medical Sciences and Public Health University of CagliariMonserrato 09042Italy Department of Systems Medicine University of Rome"Tor Vergata"Rome 00133Italy

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a frequently reported condition in patients with inflammatory bowel disease(IBD).Both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBDassociated NAFLD.AIM To evaluate the prevalence of steatosis and liver fibrosis(LF)in a cohort of IBD patients and the identification of metabolic-and IBD-related risk factors for NAFLD and LF.METHODS IBD patients were consecutively enrolled from December 2016 to January 2018.Demographic,anthropometric and biochemical data were collected so as eating habits.Abdominal ultrasound and transient elastography were performed to evaluate the presence of NAFLD and LF respectively.RESULTS A total of 178 consecutive patients were enrolled and included in the analysis(95 Ulcerative colitis,83 Crohn’s disease).NAFLD was detected by imaging in 72(40.4%)patients.Comparison between patients with and without NAFLD showed no significant differences in terms of IBD severity,disease duration,location/extension,use of IBD-related medications(i.e.,steroids,anti-TNFs,and immunomodulators)and surgery.NAFLD was significantly associated with the presence of metabolic syndrome[MetS;odds ratio(OR):4.13,P=0.001]and obesity defined by body mass index(OR:9.21,P=0.0002).IBD patients with NAFLD showed higher caloric intake and lipid consumption than those without NAFLD,regardless disease activity.At the multivariate analysis,male sex,advanced age and high lipid consumption were independent risk factors for the development of NAFLD.An increased liver stiffness was detected in 21 patients(16%)and the presence of MetS was the only relevant factor associated to LF(OR:3.40,P=0.01).CONCLUSION In this study,we demonstrate that risk factors for NAFLD and LF in the IBD population do not differ from those in the general population.

关键词： Nonalcoholic fatty liver disease Liver fibrosis Inflammatory bowel disease Risk factors Dietary habits

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