Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Clinical and Metabolic Outcomes in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Metabolic dysfunction-related steatotic liver disease (MASLD) frequently coexists with inflammatory bowel disease (IBD), yet its metabolic and clinical implications remain unclear. This systematic review and meta-analysis investigated the association between MASLD and metabolic as well as IBD-related outcomes in patients with IBD. A comprehensive search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified observational studies comparing IBD patients with and without MASLD. Four studies comprising 1,109 patients were included. Pooled analyses using fixed- and random-effects models showed that MASLD was significantly associated with higher odds of hypertension (odds ratio (OR) = 2.60; 95% CI: 1.76-3.85; p < 0.00001; I² = 18%) and diabetes mellitus (OR = 12.18; 95% CI: 3.37-44.10; p = 0.0001; I² = 70%), but not with IBD-related surgery (OR = 1.34; 95% CI: 0.89-2.02; p = 0.16; I² = 0%). No significant differences were found in total cholesterol (p = 0.10) or low-density lipid (LDL)-cholesterol (p = 0.07) between groups. Heterogeneity was low to moderate. In conclusion, MASLD in patients with IBD is associated with an increased risk of hypertension and diabetes but not with altered lipid profiles or need for IBD-related surgery, suggesting that MASLD is primarily associated with metabolic comorbidity rather than modification of bowel disease severity.