Metabolic Dysfunction-Associated Steatotic Liver Disease in Inflammatory Bowel Disease: A Cross-Sectional Study of Prevalence and Associated Factors

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) highlights the central role of metabolic dysregulation in hepatic steatosis. Patients with inflammatory bowel disease (IBD) are increasingly recognized to have an adverse cardiometabolic risk profile; however, data regarding MASLD prevalence and associated factors in this population remain limited, particularly in regions with a high metabolic burden such as Türkiye. This study aimed to determine the prevalence of MASLD in patients with IBD and to identify the metabolic and disease-related factors associated with its development. Methods: In this retrospective cross-sectional study, adult patients with IBD followed at a tertiary referral center in Türkiye were included. Hepatic steatosis was assessed using routine abdominal imaging, and MASLD was defined according to the 2023 Delphi Consensus criteria. Clinical, demographic, and metabolic variables were analyzed. Multivariable logistic regression analysis was performed to identify factors independently associated with MASLD. Results: A total of 194 IBD patients who had abdominal imaging available within the previous 6 months were included, of whom 61.3% had MASLD. MASLD was more prevalent in patients with UC than in those with CD (70.7% vs. 55.5%, p = 0.036). However, UC diagnosis was not independently associated with MASLD after multivariable adjustment. Patients with MASLD were older and had higher body mass index and less favorable metabolic profiles. In multivariable analysis, age (OR 1.055, 95% CI 1.022–1.089; p < 0.001), body mass index (OR 1.199, 95% CI 1.092–1.316; p < 0.001), and triglyceride levels (OR 1.012, 95% CI 1.004–1.020; p = 0.005) were independently associated with MASLD. In contrast, disease-related factors, including disease activity, biologic therapy, and prior surgery, were not independently associated with MASLD. Conclusions: MASLD prevalence was high among selected IBD patients with available abdominal imaging and appears to be more strongly associated with metabolic risk factors than with disease-specific characteristics. In populations with a high background cardiometabolic burden, MASLD in IBD may largely reflect the underlying regional metabolic milieu. These findings support the integration of metabolic risk assessment and proactive MASLD screening into routine IBD care. Prospective longitudinal studies are needed to clarify the causal relationship between metabolic dysfunction, IBD-related factors, and MASLD progression.