ORLANDO, Fla. — A combination of inflammatory bowel disease and metabolic syndrome increased the risk for developing nonalcoholic fatty liver disease, according to data presented at Digestive Disease Week.
Using data collected from the University of Pennsylvania electronic health care record, researchers performed a retrospective chart review of 10,863 patients with NAFLD seen between 1997 and 2011. IBD was present in 297 cases, with a dual diagnosis of IBD and NAFLD in 37 patients, including 11 with ulcerative colitis and 26 with Crohn’s disease.
Patients with any three of the following characteristics were considered to have metabolic syndrome (MetS): BMI greater than 30 kg/m2, diabetes/insulin resistance, hypertension or hyperlipidemia. Liver biopsy or BARD fibrosis score was used to determine NAFLD severity, while IBD severity was indicated via Montreal classification and physician global assessment.
“Intestinal inflammation and bacterial translocation have been implicated in the pathogenesis of NAFLD,” the researchers wrote. “It is unknown, however, whether the combination of obesity and chronic intestinal inflammation in IBD patients increases NAFLD risk or severity.”
Among the 37 patients with dual IBD/NAFLD diagnoses, the mean BMI was 31 kg/m2 . At NAFLD diagnosis, the mean C-reactive protein (CRP) was 30.7, 35% of participants had MetS, and 62.2% had severe IBD. Eighty-one percent of this subset had BARD scores between 2 and 4. Patients with MetS had significantly greater estimated NAFLD severity compared with those without MetS (P=.048). Bilirubin levels were significantly higher among MetS patients (0.9 compared with 0.5; P=.004), but alanine aminotransferase, aspartate aminotransferase, CRP and erythrocyte sedimentation rate levels did not differ according to MetS presence.
“Patients with more severe IBD tend to have a higher risk of progression to NAFLD,” researcher Arpan Patel, MD, a resident at the University of Pennsylvania, told Healio.com. “Patients who carry a dual diagnosis [of metabolic syndrome] have higher BARD scores, which correlate to worsening NAFLD severity. If you have a patient with IBD, and they have metabolic syndrome, you should be worried about NAFLD in that patient.”
Disclosure: Researcher Gary R. Lichtenstein, MD, reported numerous financial disclosures.
For more information:
Carr RM. Mo1261: Metabolic Syndrome and IBD Severity May Increase Risk of NAFLD. Presented at: Digestive Disease Week 2013; May 18-21, Orlando, Fla.