S1477 MASLD Does Not Worsen Outcomes in IBD: A Retrospective Cohort Analysis

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects a significant proportion of the global and U.S. population and is associated with increased mortality. While inflammatory bowel disease (IBD) is known to contribute to metabolic disturbances and MASLD development, the reverse relationship of how MASLD affects IBD outcomes remains uncertain. This study aims to evaluate the impact of MASLD on IBD outcomes using real-world data. Methods: A retrospective cohort study was conducted using the TriNetX database from January 2014 to January 2019. Cohort A included adult patients with Crohn’s Disease (CD) or Ulcerative Colitis (UC) and had a diagnosis of MASLD while cohort B included CD or UC patients without MASLD. Patients with the presence of hepatitis, hepatocellular carcinoma, and hepatic fibrosis were excluded. Propensity score matching was performed to balance confounders. Primary outcomes included hospitalization, colectomy, and all-cause mortality. Secondary outcomes included Clostridioides difficile and cytomegalovirus infections, toxic megacolon, and steroid use. Results: Among 33,132 Crohn’s Disease (CD) and 33,205 Ulcerative Colitis (UC) patients, 12.9% and 13.9% had MASLD, respectively. In CD, MASLD was associated with reduced hospitalization risk (HR = 0.711, P < 0.001) and steroid use (HR = 0.859, P < 0.001), with no significant differences in colectomy, mortality, or infection rates. Similarly, UC patients with MASLD showed lower hospitalization rates (HR = 0.803, P < 0.001) and steroid use (HR = 0.898, P = 0.025). In the combined IBD cohort, MASLD was linked to a reduced hospitalization rate (HR = 0.803, P = 0.001). There was no significant difference in colectomy, mortality, or infection rates between MASLD and non-MASLD groups. Conclusion: While some studies suggest MASLD worsens IBD outcomes, others report inconsistent findings. In this study, MASLD was associated with lower hospitalizations in CD, UC, and IBD overall, and lower steroid use in CD and UC. Patients with MASLD often have more frequent follow-ups, which may lead to earlier interventions. The observed reduction in steroid use may reflect alternative treatment strategies prioritizing metabolic health. Further research is needed to explore these mechanisms.