Prevalence of metabolic dysfunction-associated steatotic liver disease in inflammatory bowel disease patients: an Egyptian cross-sectional study

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a global health concern, with projections indicating it may become the leading cause of liver transplantation. MASLD is an updated terminology for NAFLD (non-alcoholic fatty liver disease), is characterized by hepatic steatosis with concurrent at least one cardiometabolic risk factor, primarily influenced by dietary habits, in the absence of secondary causes such as alcoholism, Concurrently, the incidence of inflammatory bowel disease (IBD) is rising in the Arab world. Traditionally considered a wasting disease, recent studies suggest an increased prevalence of MASLD among IBD patients compared to the general population. This study aimed to determine the prevalence of MASLD in IBD patients and assess the contributing risk factors. Study design and methodology A cross-sectional analytical study was conducted across two centers, including 81 patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD), with no prior hepatic disease or alcohol intake. After obtaining informed consent, patients underwent: clinical assessment (history, examination), Laboratory investigations (lipid profile, liver enzymes) Fibro Scan with Controlled Attenuation Parameter (CAP score) to quantify liver steatosis. Patients were classified into two groups: IBD with steatosis group: CAP > 217 dB/m, IBD without steatosis group: CAP ≤ 217 dB/m. Statistical analysis was performed to compare risk factors between groups. Results 42.5% of IBD patients had liver steatosis, 23.7% had MASLD, in comparing risk factors in steatotic and non steatotic groups, they did not differ regarding their IBD phenotype, extension, presence or absence of extraintestinal manifestations, disease duration, disease activity, and type of treatment received. Regarding non-IBD risk factors, the steatosis group was older with higher body mass index, higher triglyceride, cholesterol, and glycated hemoglobin level. Conclusion Steatotic liver disease affects nearly less than half of IBD patients, primarily due to metabolic risk factors rather than IBD-specific characteristics. These findings highlight the importance of early metabolic screening in IBD patients to mitigate MASLD progression.