Introduction

About 30% of Crohn’s disease(CD) patients complicated with non-alcoholic fatty liver disease(NAFLD), and it was mainly lean NAFLD. Whether the patients with lean NAFLD have specific characteristics in human body composition is unclear. This study aimed to analyze the body composition in lean NAFLD patients in a CD cohort.

Aims & Methods

Consecutive patients diagnosed between January 2021 and June 2021 were retrospectively enrolled in a tertiary center in China. NAFLD was diagnosed by clinical characteristics and CT imaging. Human body composition was calculated by bioelectrical impedance analysis (BIA). The differences of clinical characteristics and human body composition of lean NAFLD was analyzed and compared to non-NAFLD and non-lean NAFLD.

Results

A total of 422 CD patients were enrolled. The overall prevalence of NAFLD was 13.03% (55/422), with 37 lean and 18 non-lean NAFLD. Compared to Non-NAFLD patients, CD patients with NAFLD tend to had a higher body fat mass (BFM) (13.70[8.20-20.30] vs. 10.20[7.50-14.30], P=0.001) and visceral fat level (VFL) (5[3-8] vs. 4[3-5], P=0.002). These differences may mainly contributed by the non-lean NAFLD, for no difference was found between lean NAFLD and non-NAFLD group. When compared to non-lean NAFLD, CD patients with lean NAFLD showed a lower body mass index (BMI) (19.10[17.50-20.30] vs. 25.45[24.45-27.70], P＜0.001), protein (8.30[6.95-9.40] vs. 10.40[7.85-11.43], P=0.007), minerals (2.92±0.52 vs. 3.40±0.68, P＜0.001), body fat mass (BFM)(10.62±4.24 vs. 23.52±6.98, P＜0.001), percent body fat (PBF)(17.40[13.00-27.75] vs. 29.55[27.73-33.98], P＜0.001), skeletal muscle mass (SMM) (23.10[18.85-26.55] vs. 29.35[21.70-32.40], P=0.008) and VFL (4[2-5] vs. 9[7-11], P＜0.001).

Conclusion

Different to non-lean NAFLD in the present CD cohort, lean NAFLD showed a strong relationship to malnutrition. It suggested that different mechanisms may exist in lean and non-lean NAFLD in CD population.

Disclosure

The authors declare no conflict of interest. All the authors have looked through the paper and approved the submission.

Introduction

Nowadays, Non-Alcoholic Fatty Liver Disease (NAFLD) is a leading cause of liver disease and liver transplantation. Although obesity is a well-recognized risk factor for NAFLD, there are data to support that not all patients with NAFLD are necessarily obese. However, the evidence on the prevalence and risk factors for NAFLD in lean individuals with Inflammatory Bowel Disease (IBD) is scarce.

Aims & Methods

The aim of the study was to assess the prevalence and risk factors for NAFLD in lean population with IBD. This is a cross-sectional, case control study including lean individuals with IBD (cases) and lean individuals without IBD (controls), matched for age and sex. Patients with risky alcohol consumption, previous diagnosis of chronic liver disease (immune, viral, genetic) and secondary causes of NAFLD were excluded. All included patients were performed a liver ultrasound, transient elastography and laboratory tests. Lean individuals were defined as Body Mass Index < 25 kg/m², and NAFLD as ultrasound steatosis and/or Controlled Attenuation Paremeter >248 dB/m. A descriptive analysis was carried out, and the relationship between variables was assessed using Chi square test/Fisher´s test (categorical variables) or T-student/Mann-Whitney U test (quantitative variables), as appropiate. In addition, a multivariate analysis was performed, presented as adjusted Odds Ratio (OR) and 95% Confidence Interval (95%CI).

Results

A total of 443 participants, 363 lean cases and 80 lean controls, were included in the study. No differences were observed in terms of age, sex and metabolic risk factors between both groups (Table 1). The prevalence of NAFLD in lean individuals with IBD was significantly higher compared to lean individuals without NAFLD (22% vs. 10%, p=0.015). Multivariate analysis confirmed that IBD was an independent risk factor for NAFLD in lean population (OR 2.75 95%CI (1.18-6.41)). In addition, male sex (OR 1.78 95%CI (1.04-3.05)) and older age (OR 1.03 95%CI (1.01-1.05)) were identified as risk factors for NAFLD in lean individuals.

Table 1. Baseline characteristics of cases and controls.

Conclusion

The prevalence of NAFLD is significantly higher in lean population with IBD, suggesting that IBD could play a role in the development of NAFLD in lean individuals.

Disclosure

This project has received funding from “Diputación General de Aragón” (code: DGACOVID-02).

Introduction

Non-alcoholic liver disease (NAFLD) is a leading cause of liver-related morbidity and mortality having an overall prevalence of about 30%. Inflammatory bowel diseases (IBD) are caused by a dysregulated immune response in the hosts, favored by genetic susceptibility. In addition to symptoms related to the digestive tract, about 40% of patients with IBD also experience extraintestinal manifestations. Although, NAFLD has been frequently associated with IBDs, the relationship between these two pathologies remains unclear.

Aims & Methods

The aim of this study was to investigate the prevalence of NAFLD among IBD patients, as well as the factors that connect these two conditions.From January 2022 to November 2022, consecutive IBD patients were enrolled from a tertiary care center hospital in Iasi. All patients' demographic information, clinical characteristics including blood pressure, biological parameters, and anthropometric measurements were collected. Following informed consent, participants underwent a fibroscan evaluation for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP).

Results

A total of 93 patients with IBD were enrolled (65,3% men, 55,6% with ulcerative colitis). 45 (48,3%) of them were diagnosed with NAFLD, with a mean CAP score of 283 ± 33.4 vs. 215 ± 23.7 in patients with IBD only. Regarding liver fibrosis, mean LSM value in the NAFLD group was 6.8 ± 1.9 kPa vs. 5.7 ± 2.3 kPa in the non-NALFD group. Subjects with NAFLD exhibited higher body mass indexes than those with IBD only (26.2 vs. 33.1, p<0.05). In addition, the prevalence of diabetes was much greater among this group (27.5% vs. 0%; p=0.0001), as was the prevalence of elevated HbA1c levels in the absence of a diabetes diagnosis (14% vs. 7.35%; p=0.23). They also had a non-significantly higher mean systolic blood pressure and greater incidences of hypertension. Age (β=0.357, p=0.034), body mass index (BMI) (β=0.185, p=0.048), disease duration (β=0.297, p=0.037), C - reactive protein (β=0.321, p=0.013), fasting plasma glucose (β=0.269, p=0.018) and triglycerides (β=0.273, p=0.021) were strongly associated at the multivariate analysis with the diagnosis of NAFLD in our cohort of patients with IBD. Advanced fibrosis (LSM > 9.7 kPa) was associated with age, BMI and the level of triglycerides. After adjusting for classic metabolic risk factors, age and gender the multivariate logistic regression analysis showed that the presence of IBD (odds ratio, 2.45; 95% confidence interval,1.17–4.391; p < 0.001). Also, in regard to age and male gender they were independent risk factors for NAFLD. Of note, the 10-year risk of myocardial infarction or death estimated by the Framingham risk scores for hard coronary heart disease was higher in the NAFLD group (2.32% vs. 4.27%, p=0.0024).

Conclusion

NAFLD is an intricate condition that has become more common in IBD patients. The connection between these two pathologies is not fully understood, although metabolic disorders, age and male gender have a notable role. Current evidence in the literature suggests a minor risk for the progression of liver fibrosis, the cardiovascular risk appears to be of more concern. Given the information presented above, patients with IBD should be assessed using a multidisciplinary approach.

Introduction

Non-alcoholic fatty liver disease (NAFLD) prevalence is elevated in patients with inflammatory bowel disease (IBD) in Western nations. Both intestinal inflammation and metabolic factors contribute to IBD-associated NAFLD. However, the burden of NAFLD in non-Western populations remains unclear.

Aims & Methods

This study aimed to evaluate the prevalence of NAFLD and liver fibrosis in a cohort of Tunisian IBD patients.

Results

Conclusion

This study demonstrates a 28.57% prevalence of NAFLD in Tunisian IBD patients. Higher BMI and older age at IBD diagnosis were associated with NAFLD. Hepatic fibrosis occurred predominantly in Crohn's disease patients. Further longitudinal studies are warranted to elucidate the impact of IBD on hepatic complications.

Introduction

The relationship between obesity and inflammatory bowel disease (IBD) is currently undefined. The clinical outcome of obese and non-obese IBD patients is apparently comparable. However, evidences at this regard are conflictual.

Aims & Methods

Primary aim was to compare, in a prospective study, IBD characteristics between overweight or obese and non-obese consecutive IBD patients. Secondary aim was to compare the frequency of immunomodulator therapies, IBD-related surgery and hospitalizations between overweight or obese and non-obese patients.
In a prospective, single-center study, consecutive IBD patients undergoing scheduled outpatients visit between September 2022 and January 2023 were enrolled. Demoghaphic and clinical data including body mass index (BMI) were recorded. Inclusion criteria: 1)defined diagnosis of IBD; 2)age ≥18 years; 3)regular follow up (≥2 visits/year). Exclusion criteria: 1)BMI <18.5 mk/m², 2)incomplete data. Data were expressed as median [range]. Normal distribution of continuous variables tested by the Kolmogonov-Smirnov test. Comparisons assessed by Student-t test, Mann-Whitney u-test and Chi-squared test.

Results

Out of 300 IBD patients assessed, 284 were enrolled (141 [49.6%] Crohn’s Disease (CD); 143 [50.4%] UC). The median age of IBD group was 51 [20-87] and male gender was observed in 157 (55.3%) patients. The median IBD duration was 13.5 [1-57] years. Overall, 170 (59.8%) IBD patients were normal-weight and 114 (40.2%) were overweight or obese.
Among the 141 CD patients enrolled, 89 (63.1%) normal-weight patients and 52 (36.9%) overweight or obese patients were observed. Lesions distribution and behavior was comparable between normal-weight and overweight or obese patients (L1: 62 [70%] vs 35 [67.3%], p=0.77; L2: 8 [9%] vs 4 [7.7%], p=0.79; L3: 19 [21%] vs 13 [25%], p=0.61; L4: 7 [7.9%] vs 2 [3.8%], p=0.34; B1: 24 [27%] vs 13 [25%], p=0.79; B2: 44 [49.4%] vs 32 [61.5%], p=0.16; B3: 21 [23.6%] vs 7 [13.5%], p=0.74, respectively). Perianal disease was more frequently observed in overweight or obese vs normal-weight patients (9 [10.1%] vs 12 [23%], p=0.03). Immunosuppressive (ISS) or biologic use was comparable between groups (ISS: 33 [37%] vs 19 [36.5%], p=0.94; biologics: 23 [25.8%] vs 17 [32.7%], p=0.38). Lack of response to biologics was more frequently observed in overweight and obese vs normal-weight patients (0 [0%] vs 4 [23.4%], p=0.01). Loss of response and adverse events were comparable between groups (11 [47.8%] vs 5 [29.4%], p=0.23; 13 [56.5] vs 8 [47.1%], p=0.55).
Among the 143 UC patients enrolled, 81 (56.6%) normal-weight patients and 62 (63.4%) overweight or obese patients were observed. Proctitis and extensive UC were more frequently reported in overweight or obese vs normal-weight patients (E1: 18 [29%] vs 11 [13.6%], p=0.02; E3: 35 [56.4%] vs 31 [38.3%], p=0.03). Left-sided UC were more frequent in normal-weight then in overweight or obese patients (E2: 39 [48.1%] vs 19 [30.6%], p=0.03). ISS use was comparable between groups (14 [17.3%] vs 7 [11.3%], p=0.31) while biologics were more frequent in normal-weight then in overweight or obese patients (15 [18.5%] vs 4 [6.4%], p=0.03). Lack of response, loss of response and adverse events were comparable between groups (6 [40%] vs 1 [25%], p=0.58; 5 [33.3%] vs 1 [25%], p=0.75; 6 [40%] vs 0 [0%], p=0.12).

Conclusion

In the tested population, overweight or obese CD patients showed a higher frequency of perianal disease and refractoriness to biologics than normal weight patients. These preliminary findings in CD suggest that BMI and phenotype may influence responsiveness to biologics.

Introduction

Malnutrition and weight loss are well-recognized complications of Crohn disease (CD), however nutritional routine assessment is not commonly performed, resulting in under-detection of both malnutrition and nutrient deficiencies. In fact, a number of nutrition screening tools are available including the Nutritional Risk Index (NRI).
The aim of this study was to assess the nutritional status using the NRI and to investigate the associated factors to malnutrition during CD.

Aims & Methods

We conducted a retrospective single-center study, including patients followed for CD over a 7-year period [2014 - 2021]. Malnutrition risk was estimated based on the NRI calculated at first presentation with the following formula: NRI = (1.519 × serum albumin (g/L) + 41.7× (present weight/usual weight).
Nutrition status of patients was categorized into four groups: NRI>100: no risk group, NRI= 97.5–100: mild risk, NRI= 83.5–97.5: moderate risk, and NRI< 83.5: severe risk group of malnurition. Radiologic sarcopenia was assessed by calculating the total psoas area index.

Results

In total, 50 patients were enrolled with a mean age of 44.3 years, a median disease duration of 106 months and a sex ratio M/F of 3.16.
Based on NRI, 11/50 (22%) patients had normal nutritional status, 27/50 (54%) mild-moderate risk of malnutriton and 12/50 (24%) had severe malnutrition.
In the univariate study, severe malnutrition risk was associated with the presence of anemia (p=0.002), thrombocytosis (p=0.05), hypocholesterolemia (p=0.024), the presence of radiologic sarcopenia (p=0.05), extensive ileal involvement of more than 50 cm (p=0.014), the occurrence of complications such as intra-abdominal collection (p=0.001) and thromboembolic complications (p=0.05). Regarding, patients who underwent surgical treatment, the occurrence of postoperative complications and extensive small bowl resection were factors associated with severe malnutrition with a p-value of 0.02 and 0.025 respectively.
On multivariate regression analysis, severe malnutrition risk was a predictive factor of developing intra-abdominal abscess (OR 10.5 95% CI 2.22-49.51), p=0.003).

Conclusion

Patients with Crohn’s disease have a high incidence of nutritional risk and malnutrition witch was associated with severe course of CD. Nutritional Risk Index is a simple, validated and reproducible tool to identify patients at increased risk of malnutrition allowing adapted nutritional support.

Introduction

Current treatments for Crohn’s disease (CD) and ulcerative colitis (UC) are associated with loss of treatment response. However, studies assessing the real-world burden of non-response in Canada are scarce and the clinical and humanistic burden remains unknown. We aimed to describe the burden of active disease on symptom prevalence and work impairment by describing patients with CD and UC according to remission status.

Aims & Methods

Data were drawn from the Adelphi Real World Inflammatory Bowel Disease Specific Programme™, a real-world, cross-sectional survey of gastroenterologists (GEs) and their consulting patients with CD and UC in Canada from June 2023 to January 2024. Data included physician-reported patient demographics and clinical characteristics. Descriptive analyses were conducted.

Results

19 physicians reported data for 144 patients (73 with CD and 71 with UC). Physicians reported 20% of patients not to be in clinical or endoscopic remission (non-remitters), 31% to be in clinical remission only and 49% in both clinical and endoscopic remission. Mean (standard deviation) age was 44.5 (20.5) years among non-remitting patients, 33.5 (13.3) years among those in clinical remission only and 40.4 (17.4) years among patients in those with clinical and endoscopic remission. Among non-remitting patients, 38% were an ex-smoker, versus 14% of clinical remission and 18% of clinical and endoscopic remission patients. The most reported comorbid conditions included anxiety (24% non-remitters, 14% clinical remitters, 18% clinical and endoscopic remitters), depression (14% non-remitters, 0% in clinical remitters, and 14% in clinical and endoscopic remitters) and hypertension (14% non-remitters, 9% clinical remitters, and 14% clinical and endoscopic remitters). Top three current symptoms included fatigue (52% non-remitters, 32% clinical remitters, 15% clinical and endoscopic remitters), abdominal pain (69% non-remitters, 14% clinical remitters, 7% clinical and endoscopic remitters), and non-bloody diarrhea (48% non-remitters, 7% clinical remitters, 6% clinical and endoscopic remitters). Regarding employment, 38% of non-remitters were working full-time versus 48% of clinical remitters, and 58% of clinical and endoscopic remitters.

Conclusion

Patients with CD/UC that had not achieved or maintained remission experienced more symptom burden, comorbid conditions, and were often not in full-time employment than those in disease remission. Notably, non-remitters experienced a high symptom burden, including fatigue, abdominal pain, and diarrhea, which impacted daily living. Patients with both clinical and endoscopic remission experienced fewer symptoms and full-time employment. This highlights the importance of, and significant unmet need for, effective treatment in IBD to manage disease symptoms and decrease inflammation.

Disclosure

Janssen Global Services funded the research and I am an employee of Janssen