Role of non-invasive measures in detection of prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in patients with inflammatory bowel disease

Abstract Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions defined by gastrointestinal inflammation. This study aimed to detect the prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in patients with IBD using non-invasive measures, including laboratory investigations and FibroScan. It also evaluated risk factors for MASLD in this population and investigated the relationship between IBD severity and the degree of hepatic steatosis. Materials and methods A case-control study was carried out on 105 participants who presented to Fayoum University Hospital between May 2024 and January 2026. This included 54 patients with IBD and 51 apparently healthy controls. Patients with IBD were further divided into 5 with CD and 49 with UC, none of whom had a history of chronic liver disease. All participants underwent full medical history, clinical assessment, laboratory investigations, abdominal ultrasound, and FibroScan to measure the Controlled Attenuation Parameter (CAP). Results Receiver operating characteristic (ROC) analysis demonstrated superior diagnostic accuracy for CAP (Area under the curve [AUC] 0.979, sensitivity 93.3%, specificity 97.4% at 225 dB/m) compared to the Hepatic Steatosis Index (HSI) (AUC 0.744, sensitivity 60%, specificity 87.2% at 36.7) in the IBD group. In the control group, ROC analysis revealed perfect diagnostic accuracy for CAP (AUC 1.000, 100% sensitivity/specificity at 217 dB/m) versus good but inferior performance for HSI (AUC 0.805, 82.8% sensitivity, 72.7% specificity at 34.55). Conclusion Our study demonstrates a lower prevalence of MASLD and steatosis in patients with IBD compared to controls. The groups differed substantially in anthropometric and metabolic characteristics, which may have contributed to this difference. No statistically significant association was found between IBD severity and steatosis. Metabolic risk factors appear to drive MASLD overlap, while CAP showed greater apparent discriminative performance than HSI; however, the findings require cautious interpretation given the sample size.