Liver and Bile
Clin Gastroenterol Hepatol. 2023;21(2):406–14.e7
Increased risk of MAFLD and liver fibrosis in inflammatory bowel disease independent of classic metabolic risk factors
Background and 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). The authors aimed to determine MAFLD prevalence and risk factors in IBD patients.
Methods: The 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: 831 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 < 0.001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio [aOR] = 1.99; p < 0.001) and an independent risk factor for advanced liver fibrosis (aOR = 5.55; p < 0.001). 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: Metabolic-associated fatty liver disease and liver fibrosis are particularly prevalent in patients with inflammatory bowel disease, regardless of the influence of classic metabolic risk factors.