ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Assessment of Liver Stiffness and Steatosis in Patients with Intestinal Failure: A Cross-Sectional Study
Provisionally accepted
Ena Muhic1*
Rahim Naimi1
Christopher Brandt Filtenborg1
Thomas Lund Andersen2Helle Hjorth Johannesen2
Palle Bekker Jeppesen1- 1Department of Digestive Diseases, Transplantation and General Surgery, Section of Intestinal Failure, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- 2Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Intestinal failure-associated liver disease is a potentially life-threatening complication in patients with intestinal failure (IF) receiving home parenteral support (HPS). The aim of this study was to evaluate liver stiffness and steatosis non-invasively in adult patients with IF receiving long-term HPS. Patients with IF on a stable HPS prescription (≥ 4 days/week for ≥ 10 weeks) were included in this cross-sectional study. Liver stiffness measurements (LSMs) were assessed by transient elastography, and steatosis by MRI-proton density fat fraction (MRI-PDFF). Blood samples were analyzed for liver function. Data were compared to sex-and age-matched controls. A total of 33 patients (median age, 57 years; BMI, 23 kg/m2) and 14 controls (median age, 58 years; BMI, 24 kg/m2) were examined. Patients had higher LSMs compared to controls (5.6 kPa vs. 4.3 kPa; p = 0.0079). Elevated LSMs (>7 kPa) were seen in 37% of patients vs. 0% in controls (p = 0.0085). LSMs were associated with HPS energy (p = 0.026) and lipid content (p = 0.029). Median MRI-PDFF was 1.8% in patients and 1.5% in controls (p = 0.43). Nineteen percent of patients exhibited elevated MRI-PDFF (≥ 8%) vs. 7% in controls (p = 0.41). Alkaline phosphatase and gamma-glutamyltransferase levels > 1.5x the ULN were observed in 21% and 45% of patients, respectively. Overall, these results indicate that in this adult IF population, elevated LSMs and a cholestatic pattern in liver enzymes were more prevalent than steatosis as assessed by MRI-PDFF. Patients at risk of increased liver stiffness appeared to have severe IF as indicated by high HPS energy and lipid requirements.
Keywords: Parenteral Nutrition, intestinal failure, home parenteral support, intestinal failure-associated liver disease, Short Bowel Syndrome, steatosis, Liver stiffness
Received: 03 Oct 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Muhic, Naimi, Filtenborg, Andersen, Johannesen and Jeppesen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ena Muhic, ena.muhic@regionh.dk
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