Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China.
Chin Med J (Engl). 2024 Jul 20;137(14):1705-1714. doi: 10.1097/CM9.0000000000002859. Epub 2023 Nov 13.
Non-alcoholic fatty liver disease (NAFLD) and inflammatory bowel disease (IBD) have shown similar worsening epidemic patterns globally and shared various overlapping pathophysiological mechanisms. However, evidence on the relationship between NAFLD and IBD risk is lacking. We aimed to investigate the associations between long-term risk of incident IBD and NAFLD in a large prospective cohort.
Participants from the United Kingdom Biobank cohort ( https://biobank.ndph.ox.ac.uk/ ) who were free of IBD and alcoholic liver disease at baseline were enrolled. Baseline non-alcoholic fatty liver degree was measured by the well-established fatty liver index (FLI). The outcomes of interest included incident IBD, ulcerative colitis (UC), and Crohn's disease (CD). Multivariable Cox proportional hazard regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Among 418,721 participants (mean FLI: 48.11 ± 30.11), 160,807 (38.40%) participants were diagnosed as NAFLD at baseline. During a median of 12.4 years' follow-up, 2346 incident IBD cases (1545 UC, 653 CD, and 148 IBD-unclassified) were identified. Due to limited events, those IBD-unclassified were combined in UC or CD when examining the associated risk of UC or CD, separately. Compared with the lowest quartile of FLI, the highest quartile showed a separately 36.00%, 25.00%, and 58.00% higher risk of incident IBD (HR Q4 vs.Q1 = 1.36, 95% CI: 1.19-1.55, Ptrend <0.001), UC (HR Q4 vs.Q1 = 1.25, 95% CI: 1.07-1.46, Ptrend = 0.047), and CD (HR Q4 vs.Q1 = 1.58, 95% CI: 1.26-1.97, Ptrend <0.001) after multivariable adjustment. Compared with non-NAFLD, NAFLD participants had a significantly higher risk of incident IBD (HR = 1.13, 95% CI: 1.04-1.24) and CD (HR = 1.36, 95% CI: 1.17-1.58).
Higher degree of non-alcoholic fatty liver is associated with increased risk of incident IBD. Interventions aimed at improving NAFLD may be a potential targeted strategy for the detection and treatment of IBD.
非酒精性脂肪性肝病 (NAFLD) 和炎症性肠病 (IBD) 在全球范围内表现出相似的恶化流行模式，并且具有共同的多种重叠的病理生理机制。然而，NAFLD 和 IBD 风险之间的关系的证据尚缺乏。我们旨在研究大型前瞻性队列中长期发生 IBD 的风险与 NAFLD 之间的关系。
本研究纳入了英国生物库队列（https://biobank.ndph.ox.ac.uk/）的参与者，这些参与者在基线时无 IBD 和酒精性肝病。通过公认的脂肪肝指数 (FLI) 测量基线时的非酒精性脂肪肝程度。感兴趣的结局包括新发 IBD、溃疡性结肠炎 (UC) 和克罗恩病 (CD)。使用多变量 Cox 比例风险回归计算风险比 (HR) 和 95%置信区间 (CI)。
在 418721 名参与者（平均 FLI：48.11 ± 30.11）中，160807 名（38.40%）参与者在基线时被诊断为 NAFLD。在中位数为 12.4 年的随访期间，共发现 2346 例新发 IBD 病例（1545 例 UC、653 例 CD 和 148 例 IBD 未分类）。由于事件有限，当分别检查 UC 或 CD 的相关风险时，那些 IBD 未分类的病例与 UC 或 CD 合并。与 FLI 的最低四分位数相比，最高四分位数分别显示出发生 IBD（HR Q4 vs.Q1 = 1.36，95%CI：1.19-1.55，Ptrend <0.001）、UC（HR Q4 vs.Q1 = 1.25，95%CI：1.07-1.46，Ptrend = 0.047）和 CD（HR Q4 vs.Q1 = 1.58，95%CI：1.26-1.97，Ptrend <0.001）的风险分别增加了 36.00%、25.00%和 58.00%。在进行多变量调整后，与非 NAFLD 相比，NAFLD 患者发生 IBD（HR = 1.13，95%CI：1.04-1.24）和 CD（HR = 1.36，95%CI：1.17-1.58）的风险显著增加。
非酒精性脂肪肝程度越高，发生 IBD 的风险越高。旨在改善 NAFLD 的干预措施可能是发现和治疗 IBD 的潜在靶向策略。
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