P213 Risk factors associated with NAFLD and liver fibrosis in patients with Inflammatory Bowel Disease: a prospective cohort study
Martínez-Domínguez, S.J.(1,2,3);García Mateo, S.(1,2,3);Gallego Llera, B.(3);Gargallo-Puyuelo, C.J.(1,2,3);Refaie, E.(4);Arroyo Villarino, M.T.(1,2,3);Laredo de la Torre, V.(1,3);Alfambra Cabrejas, E.(3);Gomollón García, F.(1,2,3);
(1)Hospital Clínico Universitario Lozano Blesa, Gastroenterology and Hepatology, Zaragoza, Spain;(2)University of Zaragoza, School of Medicine, Zaragoza, Spain;(3)IIS Aragón, IIS Aragón, Zaragoza, Spain;(4)University of Milan, School of Medicine, Milan, Italy;
Background
Non Alcoholic Fatty Liver Disease (NAFLD) prevalence is increasing quickly all over the world. A higher prevalence has been reported in Inflammatory Bowel Disease (IBD) patients. NAFLD is associated with increased mortality from liver and cardiovascular causes, so defining risk factors is clinically very relevant.
Methods
Consecutive IBD patients ≥ 18 years were evaluated at a reference center from October 2020 to April 2021, after giving their informed consent. They were investigated the presence of NAFLD by hepatic ultrasonography and Controlled Attenuation Parameter (CAP) performed by two trained gastroenterologists, considering steatosis in case of any degree of ultrasound steatosis or CAP > 245 dB/m. Risk of advanced liver fibrosis was considered if transient elastography was ≥ 8 kPa. Patients with risk alcohol consumption, secondary causes of steatosis or any chronic hepatic disease were excluded. In addition, a blood sample was obtained for biochemical parameters, clinical variables were recovered prospectively and medical records were reviewed. A descriptive analysis was carried out and factors potentially associated with NAFLD and liver fibrosis were analysed through logistic regression multivariate analyses. For all tests a two-sided p value <0.05 was considered statistically significant. The study was approved by local Ethical Committee.
Results
700 patients (50% women) with a median age of 50 (IQR (40-60)) years were included. In 377 (53.9%) the diagnosis was Ulcerative Colitis and in 323 (46.1%) Crohn´s Disease, the median age at diagnosis was 33 (IQR (22-42)) years. 131 (18.7%) had obesity and 238 (34%) had overweight. The prevalence of NAFLD was 42.57% and the prevalence of liver fibrosis was 7.31%.
In multivariate analysis, NAFLD was significantly associated with older age (OR (CI 95%) 1.04 (1.02-1.06), p <0.001), obesity/overweight (OR (CI 95%) 0.26 (0.17-0.39), p <0.001), waist-to-hit ratio (OR (CI 95%) 0.32 (0.21-0.48), p <0.001) and absence of active lifestyle (OR (CI 95%) 2.41 (1.44-4.05), p<0.001). No significant association was found between NAFLD and type of IBD, location, extension, pattern or the treatment of the disease. Hepatic fibrosis was significantly associated with hypertension (OR (CI 95%) 0.07 (0.10-0.45), p= 0.006) and surgical reintervention for IBD (OR (CI 95%) 6.41 (1.06-38.83), p= 0.043) in multivariate analysis, without significant association with other comorbidities, type and location of IBD or pharmacological treatment.
Conclusion
NAFLD is very prevalent in IBD and seems to be associated with the same risk factors than in the general population. Screening for NAFLD seems warranted in all IBD patients.