Risk Factors for NAFLD and Development of Advanced Fibrosis in Inflamatory Bowel Disease Patients
Bibliographic record
Abstract
Introduction: 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 examined whether MetS and IBD severity increase the risk of NAFLD severity in patients with NAFLD and IBD. Methods: A retrospective electronic medical record analysis of patients with IBD and NAFLD seen in our health system from Jan 1997-Dec 2011 was conducted. Patients were identified as having “MetS” (>3 of the following: hypertension, hyperlipidemia, BMI>30mg/kg2, and diabetes/insulin resistance) or “non-MetS.” NAFLD severity was assessed using the BARD score (score 2 or greater has an OR for advanced fibrosis of 17(85% CI 9.2-31.9) and a NPV of 96%.) IBD phenotype was assessed using the Montreal classification. IBD severity was determined by the Harvey Bradshaw Index (HBI) for Crohn's Disease (CD), and the Simple Clinical Colitis Activity Index (SCCAI) for Ulcerative Colitis (UC). Patient demographics, medications, and serology were analyzed. Statistical analysis was performed using Fisher Exact test, Mann-Whitney U test, or χ2 analysis where appropriate with P value. Results: 83 patients were included in our analysis (24 UC, 59 CD). Mean age was 52 with an average of 12.2 years between IBD diagnosis and NAFLD diagnosis and mean follow up of 16 yrs. 23% of patients had MetS. IBD patients with MetS were significantly older at the time of IBD dx (44 vs 33, p=0.005) and NAFLD dx (55 vs 46, p=0.018) and had higher BMI (34.4 vs 28.8, p < 0.001). IBD patients with MetS had higher ALT (57 U/L vs. 38 U/L, p=0.007); AST (56 U/L vs. 36 U/L, p=0.002), & Hb (14.1 v 13.1, p=0.017). Comparing the MetS patients to NonMetS patients, there was no significant difference between IBD phenotype, IBD medications (i.e. steroids, anti-TNFs, & immunomodulators), and IBD severity. MetS patients had significantly higher prevalence of advanced fibrosis based on BARD scores (95% vs 65%, p=0.009). IBD disease severity as assessed by HBI and SCCAI scores (even comparing severe disease only) was not associated with NAFLD severity. Conclusion: NAFLD is increasingly recognized as a cause of hepatic steatosis in IBD patients. IBD disease severity was not associated with advanced NAFLD. However, the presence of MetS is a risk factor for advanced liver fibrosis and should prompt hepatology referral and evaluation in IBD patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".