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Published on: September 22, 2019
Increased risk of MAFLD and Liver Fibrosis in Inflammatory Bowel Disease Independent of Classic Metabolic Risk
Juan Carlos Rodriguez-Duque1, José Luis Calleja2, Paula Iruzubieta1
1Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Santander, Spain; Group of Clinical and Translational Research in Digestive Diseases Infection, Immunity and Digestive Pathology Group, Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
Background & Aims:
There is conflicting evidence regarding the prevalence of and risk factors for metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD). We aimed to determine MAFLD prevalence and risk factors in IBD patients.
Methods:
Cross-sectional, case-control study included all consecutive IBD patients treated at 2 different university hospitals. Controls were subjects randomly selected from the general population and matched by age, sex, type 2 diabetes status, and body mass index in a 1:2 ratio. MAFLD was confirmed by controlled attenuation parameter. Liver biopsies were collected when MAFLD with significant liver fibrosis was suspected. In addition, age- and fibrosis stage-paired non-IBD patients with biopsy-proven MAFLD served as a secondary control group.
Results:
Eight hundred thirty-one IBD patients and 1718 controls were included. The prevalence of MAFLD and advanced liver fibrosis (transient elastography ≥9.7 kPa) was 42.00% and 9.50%, respectively, in IBD patients and 32.77% and 2.31%, respectively, in the general population (P < .001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio, 1.99; P < .001) and an independent risk factor for advanced liver fibrosis (adjusted odds ratio, 5.55; P < .001). Liver biopsies were obtained from 40 IBD patients; MAFLD was confirmed in all cases, and fibrosis of any degree was confirmed in 25 of 40 cases (62.5%). Body mass index and type 2 diabetes prevalence were significantly lower in IBD-MAFLD patients than in severity-paired patients with biopsy-proven MAFLD.
Conclusions:
MAFLD and liver fibrosis are particularly prevalent in IBD patients, regardless of the influence of classic metabolic risk factors.
Insights
Metabolic-associated fatty liver disease (MAFLD) and liver fibrosis are common in inflammatory bowel disease (IBD) patients. IBD itself is a significant risk factor for MAFLD and advanced liver fibrosis, independent of traditional metabolic factors.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Conflicting evidence exists on the prevalence and risk factors of metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD).
- Understanding these associations is crucial for patient management and risk stratification.
Purpose of the Study:
- To determine the prevalence of MAFLD in patients with IBD.
- To identify risk factors associated with MAFLD and advanced liver fibrosis in IBD patients.
Main Methods:
- A cross-sectional, case-control study involving 831 IBD patients and 1718 general population controls.
- MAFLD was diagnosed using controlled attenuation parameter (CAP); advanced liver fibrosis was assessed by transient elastography.
- Liver biopsies were performed when significant fibrosis was suspected.
Main Results:
- MAFLD prevalence was 42.00% in IBD patients versus 32.77% in controls (P < .001).
- Advanced liver fibrosis prevalence was 9.50% in IBD patients versus 2.31% in controls (P < .001).
- IBD diagnosis was an independent predictor of MAFLD (aOR, 1.99) and advanced liver fibrosis (aOR, 5.55).
Conclusions:
- MAFLD and liver fibrosis are highly prevalent in IBD patients.
- IBD is an independent risk factor for MAFLD and advanced liver fibrosis, even without classic metabolic risk factors.
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