Gastrointestinal functional disturbances in patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD): a cross-sectional study

This study aimed to evaluate the prevalence, spectrum, and clinical significance of gastrointestinal functional disturbances in patients with metabolic dysfunction-associated fatty liver disease (MAFLD), and their associations with disease severity, fibrosis stage, and health-related quality of life. This single-center cross-sectional study included 268 adults with MAFLD between October 2024 and October 2025. Fatty liver severity was assessed by ultrasound, and fibrosis stage was evaluated using liver stiffness measurement. Gastrointestinal functional disturbances were defined using standardized criteria. Multivariable logistic regression assessed associations with disease severity and fibrosis, and linear regression evaluated relationships with quality of life. Gastrointestinal functional disturbances were present in 46.6% of patients with MAFLD (125/268, 95% CI 40.6%–52.6%). Compared with mild disease, moderate MAFLD was associated with higher odds of gastrointestinal functional disturbances (OR = 1.68, 95% CI 1.01–2.79), while severe MAFLD showed a stronger association (OR = 2.54, 95% CI 1.36–4.73; P for trend = 0.002). Advanced fibrosis (LSM ≥ 12.4 kPa) was also independently associated with gastrointestinal functional disturbances (OR = 2.21, 95% CI 1.02–4.78). Patients with gastrointestinal functional disturbances had significantly lower SF-36 General Health scores (β = −9.15, 95% CI − 12.84 to − 5.46, P < 0.001). These associations remained robust in sensitivity analyses and after multivariable adjustment for metabolic factors, medication use, and psychological status. Gastrointestinal functional disturbances are common in MAFLD and are associated with more severe disease and impaired quality of life, highlighting the need for integrated clinical management.