Intest Res.  2023 Oct;21(4):471-480. 10.5217/ir.2023.00035.

Malnutrition and inflammation status in nonobese patients with inflammatory bowel disease are associated with nonalcoholic fatty liver disease: a retrospective study

• Nagata T
• Funakoshi S
• Morihara D
• Shakado S
• Yokoyama K
• Takata K
• Tanaka T
• Fukunaga A
• Yamauchi R
• Fukuda H
• Matsuoka H
• Imakiire S
• Sakisaka H
• Matsuoka S
• Kuno N
• Abe K
• Ishibashi H
• Ashizuka S
• Hirai F

• KMID: 2547197
• DOI: http://doi.org/10.5217/ir.2023.00035

Abstract

Background/Aims
The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD.
Methods
We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters.
Results
Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m²), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment.
Conclusions
Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

Keyword

Inflammatory bowel disease; Nonalcoholic fatty liver disease; Non-obese

Figure

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  Fig. 1. Diagram showing the patient selection process. A total of 426 patients were diagnosed with inflammatory bowel disease (IBD) at our hospital between January 2005 and October 2020. After exclusion of 330 patients for whom computed tomography (CT) scans were not available or the age was younger than 15 years and a further 10 patients with a body mass index (BMI) of ≥25 kg/m2, 86 patients with a BMI of <25 kg/m2 were enrolled.

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  Fig. 2. Number of inflammatory bowel disease (IBD) patients with or without nonalcoholic fatty liver disease (NAFLD) by body mass index.

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  Fig. 3. Bivariate analysis of hepatosplenic ratio and prognostic nutritional index (PNI) and C-reactive protein (CRP) values. (A) Bivariate analysis using the hepatosplenic ratio and PNI. The correlation was not strong (R2=0.163) but the result was significant at P<0.001. (B) Bivariate analysis using the hepatosplenic ratio and CRP. The correlation was not strong (R2=0.128) but the result was significant at P<0.001.

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  Fig. 4. Blood biochemistry findings in the year up to the computed tomography (CT) examination. (A) MANOVA tests were performed based on the prognostic nutritional index (PNI) values obtained at 1 year before, 6 months before, and at the time of the CT examination. PNI was significantly worse in the group with fatty liver than in the group without fatty liver (P<0.05). (B) Similarly, MANOVA tests were performed for C-reactive protein (CRP) levels obtained at 1 year before, 6 months before, and at the time of the CT examination. There was no significant change in the CRP level during this time (P=0.076). However, there was a slightly worse trend in the group with fatty liver than in the group without fatty liver. MANOVA, multivariate analysis of variance; NAFLD, nonalcoholic fatty liver disease.

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  Fig. 5. Blood biochemistry findings in the year after the computed tomography (CT) examination. (A) MANOVA test was performed using the prognostic nutritional index (PNI) values at the time of the CT scan and 6 months and 1 year thereafter. The group with fatty liver showed a significant improvement in PNI compared with the group without fatty liver (P<0.05). (B) Similarly, a MANOVA test was performed on the C-reactive protein (CRP) level. The group with fatty liver showed a significant improvement in the CRP level compared with the group without fatty liver (P<0.001). MANOVA, multivariate analysis of variance; NAFLD, nonalcoholic fatty liver disease.

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