Abstract
Background
Non-alcoholic fatty liver disease (NAFLD) has been progressively identified in patients with inflammatory bowel disease (IBD) in Qatar. We aim to characterise NAFLD in IBD patients in Qatar and to determine predictors for its severity.
Methods
A retrospective observational study was conducted on 913 IBD patients in Hamad hospital between January 2008 and December 2017. The prevalence of NAFLD among IBD cases was estimated and associations between two or more qualitative variables were assessed using χ2-test. Quantitative data between two independent groups were analysed using unpaired t-test. Univariate and multivariate logistic regression analysis were applied to determine the predictive values of each predictor for NAFLD among IBD patients.
Results
Among 913 IBD patients with a mean age of 36.9 ± 13.2 years and BMI 26.9 ± 6.1; 550 were males (60.2%), 383(41.9%) with Crohn’s disease and 530 (58.1%) with Ulcerative colitis. 24 (22.2%) patients had severe steatosis. The overall prevalence of NAFLD was 11.8% (95% CI 9.9, 14.1) and does not differ significantly between CD and UC patients (11.7% vs. 11.9%; p = 0.949). Patients who developed NAFLD were older at baseline, higher BMI and had a higher prevalence of diabetes and hypertension. Age >50 years (OR 3.34; 95% CI 1.82, 6.14; p = 0.001), BMI >30kg/m2 (OR 2.87; 95% CI 1.71, 4.84; p = 0.001), the presence of hypertension (OR 1.98; 95% CI 1.16, 3.38; p = 0.01) and diabetes mellitus (OR 3.05; 95% CI 1.87, 4.95; p = 0.001), were all positive and significantly associated with an increased risk whereas gender female associated with significantly decreased risk for NAFLD (OR 0.63; 95% CI 0.41, 0.98; p = 0.04). Multivariate analysis showed age >40 to 50 years (adjusted OR 2.98; 95% CI 1.62, 5.48; p = 0.001), age >50 years (adjusted OR 2.03; 95% CI 1.03, 4.0; p = 0.04), BMI>30 kg/m2 (adjusted OR 2.24; 95% CI 1.28, 3.91; p = 0.01) and diabetes mellitus (adjusted OR 1.98; 95% CI 1.15, 3.4; p = 0.02) significantly associated with an increased risk of NAFLD whereas gender female showed protective effect and have decreased risk (adjusted OR 0.58; 95% CI 0.36, 0.93; p=0.02). The treatment with biologic does not increase the risk of steatosis and the predicted cut-off NAFLD score of ≥ -1.67 had good predictive ability for significant steatosis.
Conclusion
The prevalence of NAFLD in IBD patients was 11.8% in Qatar. We did not find an association between the medications used and the progression to NAFLD in IBD patients. Older age, high BMI and diabetes mellitus increase its risk. Non-invasive screening using NAFLD Score could help early diagnosis and initiation of interventions in such patients.
High prevalence of non-alcoholic fatty liver disease in patients with inflammatory bowel disease receiving anti-tumor necrosis factor therapy
