Crohn’s disease (CD) activity is a risk factor for non-alcoholic fatty liver disease (NAFLD); however, few studies have focused on NAFLD with different CD activities. This study aimed to analyze the prevalence, risk factors, and prognosis of NAFLD in patients with active and inactive CD.

Consecutive patients diagnosed with CD between January 2014 and December 2017 were retrospectively enrolled in a tertiary center of China. The clinical characteristics and prognosis of NAFLD in patients with active and inactive CD were analyzed.

A total of 844 patients with CD were enrolled. The prevalence of NAFLD was 20.38 % (172/844), and it was mainly lean NAFLD (80.23 %). The prevalence of NAFLD and lean NAFLD was higher in active CD than in inactive CD (23.1 % vs. 15.9 %, P = 0.012, 19.5 % vs. 11.3 %, P = 0.039, respectively). In patients with CD, higher body mass index (BMI), higher C-reactive protein, and lower albumin were risk factors. Risk factors for NAFLD was low ALB in active CD. In inactive CD, the risk factors for NAFLD were higher BMI and ongoing use of azathioprine/6-Mercaptopurine. In a follow-up period of 45.46 ± 18.67 months, NAFLD was alleviated in 74.73 % (68/91) and 64.10 % (25/39) patients with active and inactive CD, respectively, after CD-related treatment.

Approximately one-fifth of patients with CD developed NAFLD, mainly lean NAFLD. NAFLD in active and inactive CD exhibits different characteristics and risk factors, suggesting that the underlying mechanisms of NAFLD in different CD activities may differ. Most of CD patients with NAFLD were alleviated after CD-related treatment.

Crohn’s disease

Non-alcoholic fatty liver disease

Disease activity

Risk factors

non-alcoholic fatty liver disease

erythrocyte sedimentation rate

Hypersensitive C-reactive protein

alanine aminotransferase

aspartate aminotransferase

gamma-glutamyltransferase

high-density lipoprotein

low-density lipoprotein

© 2025 Published by Elsevier B.V. on behalf of Pan-Arab Association of Gastroenterology.