S1249 B12 Deficiency and Its Correlation With Non-Alcoholic Fatty Liver Disease

Introduction: Liver diseases are known to correlate with low vitamin levels such as vitamin D, A, or E. Vitamin B12 deficiency and liver disease are often comorbid conditions given the high rate of dietary deficiency or malabsorption in this patient population, especially among those who have alcohol related liver disease. Some studies have shown those with non-alcoholic fatty liver disease (NAFLD) to have lower vitamin B12 levels. However, there is still little evidence on the correlation between NAFLD and B12 deficiency as well as any association with the degree of liver injury. Our study aimed to determine a correlation between vitamin B12 deficiency and NAFLD as well as NAFLD-related cirrhosis and its complications. Methods: Data from adults aged 18 and older extrapolated from IBM Explorys Cohort Discovery program was used for this study. Those with alcohol use, hepatitis B, and hepatitis C were excluded to avoid any confounding factors. We included patients who were diagnosed with B12 deficiency at least three months prior to any liver disease. Those with B12 deficiency and NAFLD, cirrhosis, and cirrhosis complications (hepatocellular carcinoma (HCC), esophageal varices (EV), and ascites) were compared with those who did not have B12 deficiency. Results: B12 deficiency was shown to be a significant risk factor for NAFLD (OR 3.16, 95% CI 3.0636-3.2531, p=0.0001) (Figure 1). Patients with cirrhosis secondary to NAFLD were also likely to have had B12 deficiency at least three months prior to their liver disease (OR 5.42, 95% CI 5.0085-5.8566, p=00001). Those with NAFLD- related cirrhosis who suffered from either EV or ascites were more likely to have preceding B12 deficiency (OR 4.79, 95% CI 4.1373-5.5534, p=0.0001 and OR 4.64, 95% CI 4.0358-5.3355, p=0.0001, respectively). Those with HCC were more likely to have a pre-existing B12 deficiency as well (OR 1.88, 95% CI 1.0088-3.4963, p=0.0469). Conclusion: NAFLD patients as well as those with cirrhosis and signs of decompensation (EV or ascites) were more likely to have B12 deficiency preceding their liver disease. This held true for those with NAFLD – related cirrhosis and HCC as a complication. This correlation with B12 deficiency is important for providers to consider when managing NAFLD patients. B12 levels as well as other vitamin levels should be checked and replenished appropriately in these patients.Figure 1.: Forest plot of mean HbA1C change in diabetic patients with HCV receiving SVR