Hepatic Steatosis but Not Fibrosis Is Independently Associated with Poor Outcomes in Patients with Inflammatory Bowel Disease

Abstract

Background/Aims Increased prevalence of nonalcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) has been reported. However, the effects of NAFLD on the outcome of IBD remains unclear. We investigated whether the presence of NAFLD could influence the outcomes of patients with IBD. Methods We recruited 3,356 eligible patients with IBD into our study between November 2005 and November 2020. Hepatic steatosis and fibrosis were diagnosed using hepatic steatosis index of ≥30 and fibrosis-4 of ≥1.45, respectively. The primary outcome was clinical relapse, defined based on the following IBD-related admission, surgery, or first use of corticosteroids, immunomodulators, or biologic agents for IBD. Results The prevalence of NAFLD in patients with IBD was 16.7%. Patients with hepatic steatosis and advanced fibrosis were older, had a higher body mass index, and were more likely to have diabetes (all p<0.05). Conclusions Hepatic steatosis was independently associated with increased risks of clinical relapse in patients with ulcerative colitis and Crohn’s disease, whereas fibrotic burden in the liver was not. Future studies should investigate whether assessment and therapeutic intervention for NAFLD will improve the clinical outcomes of patients with IBD.

Metabolic Dysfunction-Associated Fatty Liver Disease in Taiwanese Patients with Inflammatory Bowel Disease: A Study in Patients with Clinical Remission

“…Bessissow reported a prevalence of 2.2% in IBD defined as FIB-4 of ≥2.67 [29]. A recent study in Korea reports a prevalence of 5.3% in IBD with FIB-4 of ≥1.45 [21]. Ritaccio reported that 16% of patients had progressed to a NFS during 5-year follow-ups.…”

“…A few studies addressed the prevalence of MAFLD in IBD in the Asia-Pacific region (Table 5). The MAFLD prevalence was 10.7% in patients with IBD in China, 16.7% in patients with IBD in South Korea, and 21.8% in CD patients in Japan [19][20][21]. The discordance of prevalence was affected by the measurement methods and regional differences.…”

Inflammatory Bowel Diseases and Non-Alcoholic Fatty Liver Disease: Piecing a Complex Puzzle Together

“…Surprisingly, although IBD seems to increase the risk of liver disease progression, a Korean study highlighted how only hepatic steatosis but not fibrosis is associated with poor clinical outcomes. More specifically, the authors found that liver steatosis increased the risk of IBD relapse (defined as IBD-related hospitalizations or surgical interventions or the need to start treatments with corticosteroids, immunosuppressors, or biologic drugs) while fibrosis did not, both in CD and UC [ 9 ]. Therefore, the link between IBD and NAFLD appears to be even more complex, and the real burden of hepatic steatosis on IBD morbidity needs to be better defined.…”

“…In a recent systematic review analyzing the impact of NAFLD on IBD-related hospitalization outcomes, Boustany et al highlighted how NAFLD may be related to worse outcomes in individuals with IBD, despite the low quality of available data [ 8 ]. In addition, in a recently published study, Hyun et al estimated the presence of liver steatosis by calculating the Hepatic Steatosis Index (HSI) and Fibrosis-4 (FIB-4) in a cohort of 3356 IBD patients and found that steatosis was associated with increased risk of clinical relapse both in UC and CD patients [ 9 ].…”

Heavy arch: from inflammatory bowel diseases to metabolic disorders

“… 52 Moreover, the presence of MASLD (steatosis, but not fibrosis) might increase the risk of an IBD flare. 53 Despite these recent clinical observations, the origin of such observations remains unclear, but could involve gut microbial aspects along the gut-liver axis as reported for other liver diseases. 54 As for obesity, it remains understudied if MASLD and IBD affect the natural course of both diseases and related complications.…”