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Intestinal Inflammation Does Not Predict Nonalcoholic Fatty Liver Disease Severity in Inflammatory Bowel Disease Patients


Background and Aim

Nonalcoholic fatty liver disease (NAFLD) is a common cause of hepatic steatosis in patients with inflammatory bowel disease (IBD). Both metabolic syndrome (MetS) and intestinal inflammation are implicated in NAFLD pathogenesis.


We performed a retrospective cohort study of patients with IBD and NAFLD seen in our health system from January 1997 to December 2011 to examine associations between IBD severity and phenotype; MetS; and NAFLD fibrosis as estimated by the NAFLD Fibrosis Score (NFS).


A total of 84 patients were included in our analysis (24 UC, 60 CD). 23% of patients had MetS. IBD patients with MetS were significantly older at the time of IBD diagnosis (44 vs. 33, p = 0.005) and NAFLD diagnosis (55 vs. 47, p = 0.018). IBD patients with MetS had higher ALT (54 vs. 38 U/L, p = 0.02) and AST (52 vs. 35 U/L, p = 0.004). Comparing MetS patients to non-MetS IBD patients, there was no significant difference between IBD medication use (i.e., steroids, anti-TNFs, and immunomodulators) or NAFLD medication use, other than statins. Both UC and CD patients with concomitant MetS had significantly higher NFS scores than non-MetS patients: UC (−0.4 vs. −2.5, p = 0.02) and CD (−0.8 vs. −2.3, p = 0.03). IBD disease severity, disease location, or IBD medication use was associated with NAFLD severity.


To our knowledge, this is the first study to demonstrate that NAFLD severity in both UC and CD IBD patients is associated with the presence of MetS but not with the severity of IBD.

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This work was supported by the National Institutes of Health [K08-AA021424, P30 DK019525, and P30-DK050306 to RMC]; National Institutes of Health [K23 DK090209 to KF]; National Institutes of Health [T32 DK007066 to AO] and the Robert Wood Johnson Foundation [7158 to RMC].

Author's contribution

RMC, AP, CK, KF, and GRL helped in Planning and/or conducting the study; AP, HB, RMC, AP, and AO helped in collecting and/or interpreting data; RMC and AP contributed to drafting the manuscript. All authors (RMC, AP, HB, RR, KF, AP, AO, and GRL) approved the final submitted draft.

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Correspondence to Rotonya M. Carr.

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Conflict of interest

Dr. Gary R. Lichtenstein serves as consultant and/or participates in research for the following: Abbott Corporation, Abbvie, Actavis, Alaven, Celgene, Hospira, Luitpold/American Regent, Pfizer Pharmaceuticals, Prometheus Laboratories, Inc., Romark, Salix Pharmaceuticals, Valeant, Santarus, Receptos, Celgene, Shire Pharmaceuticals, Takeda, and UCB. Dr. Rotonya Carr is a sub-investigator on a research study sponsored by Intercept Pharmaceuticals.

Additional information

Rotonya M. Carr and Arpan Patel are co-first authors.

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Carr, R.M., Patel, A., Bownik, H. et al. Intestinal Inflammation Does Not Predict Nonalcoholic Fatty Liver Disease Severity in Inflammatory Bowel Disease Patients. Dig Dis Sci 62, 1354–1361 (2017).

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  • Inflammatory bowel disease
  • Crohn’s disease
  • Ulcerative colitis
  • Nonalcoholic fatty liver disease
  • NAFLD Fibrosis Score