/Aims: Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect 17-46% of western countries, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of the metabolic syndrome (MetS) in a large multicentric cohort of patients with autoimmune hepatitis (AIH).

Data from 6 academic centers (Greece, Canada, Japan, Germany, The Netherlands, and Spain) were evaluated. The presence of NAFLD/NASH in liver biopsy, MetS components and clinical and laboratory parameters were recorded.

640 patients [474 females, age 49(4-87) years; follow-up 78(1-521) months] were included. NAFLD was present in 146(22.8%) patients [AIH/NAFL 115(18%), AIH/NASH 31(4.8%)]. AIH/NAFL patients were older (p=0.017), more frequently overweight or obese (p=0.002), hypertensive (p=0.001), and diabetic (p=0.016), while they had less frequently acute presentation (p=0.002) and SLA/LP positivity (p<0.05), lower transaminases (p<0.001), ALP (p=0.028) and IgG (p=0.004) and higher albumin (p<0.001) than AIH-only patients. AIH/NASH patients had more frequently cirrhosis at diagnosis (p=0.036) and higher IgG (p=0.009). Response to treatment did not differ between groups. Cirrhotic patients with AIH/NAFL had higher frequency of decompensation compared to AIH-only patients (p<0.05). Patients with type 2 diabetes mellitus (T2DM) and dyslipidemia had increased hazard of disease progression (p<0.05 for each).

The prevalence of NAFLD in AIH is similar to the general population. Concurrence of NASH in AIH patients signifies a more severe disease, while that of NAFL may indicate a worse prognosis in cirrhotic patients. T2DM and dyslipidemia in AIH patients are associated with dismal parameters of outcome. Our findings suggest that NAFLD presence or even components of MetS in AIH patients may affect prognosis, so closer follow-up of such patients is warranted.

Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect many people, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of the metabolic syndrome (MetS) in patients with autoimmune hepatitis (AIH). NAFLD and NASH presence in AIH patients is frequent as in the general population. The concurrence of NASH in AIH patients seems to signify a more severe disease, while that of NAFL may indicate a worse prognosis in a specific subgroup of already cirrhotic patients at diagnosis. Diabetes or dyslipidemia in AIH patients were associated with worse prognosis. Therefore, it seems that closer follow-up of patients with concurrent AIH and NAFLD or AIH and components of MetS is needed.