Inflammatory Bowel Disease Is an Independent Risk Factor for Metabolic Dysfunction-Associated Steatotic Liver Disease in Lean Individuals

Abstract

Background: Despite classical association between metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, there is increasing evidence on the development of MASLD in lean individuals. The aim of the study was to assess the prevalence and risk factors of MASLD and significant liver fibrosis in lean participants with inflammatory bowel disease (IBD).

Methods: This was a cross-sectional, case-control study including 300 lean cases with IBD and 80 lean controls without IBD, matched by sex and age. All participants underwent a liver ultrasound, transient elastography, and laboratory tests.

Results: The lean IBD group showed a significantly higher prevalence of MASLD compared with lean non-IBD group (21.3% vs 10%; P = .022), but no differences were observed in the prevalence of significant liver fibrosis (4.7% vs 0.0%; P = 1.000). No differences were found between the prevalence of MASLD in IBD and non-IBD participants who were overweight/obese (66.8% vs 70.8%; P = .442). In addition, the prevalence of MASLD was significantly higher in the overweight/obese IBD group compared with the lean IBD group (P < .001). IBD was an independent risk factor for MASLD in lean participants (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.05-7.01; P = .04), after adjusting for classic metabolic risk factors and prior history of systemic steroid use. Nevertheless, no association between IBD related factors and MASLD was identified in lean IBD participants. When the overweight/obese and lean IBD groups with MASLD were compared, the overweight/obese IBD group with MASLD showed higher levels of the homeostatic model assessment of insulin resistance (OR, 1.49; 95% CI, 1.11-1.98; P = .007) and history of smoking (OR, 4.66; 95% CI, 1.17-18.49; P = .029).

Conclusions: MASLD prevalence was higher in the lean IBD group compared with lean non-IBD group, independent of classic metabolic risk factors.

Keywords: Crohn’s disease; inflammatory bowel disease; lean MASLD; liver fibrosis; ulcerative colitis.

Graphical Abstract

Figure 1.

Flowchart of participant selection: (A) cases, (B) controls. BMI, body mass index; HBV, hepatitis B virus; HCV, hepatitis C virus; IBD, inflammatory bowel disease.

Figure 2.

Prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in cases and controls according to body mass index (BMI) status. Blue bars: cases (inflammatory bowel disease). Red bars: controls (non–inflammatory bowel disease). P values in bold indicate statistical significance (P < .05).

Figure 3.

Prevalence of significant liver fibrosis in participants with metabolic dysfunction–associated steatotic liver disease according to body mass index (BMI) status. Blue bars: cases (inflammatory bowel disease). Red bars: controls (non-IBD).

Figure 4.

Logistic regression analysis of metabolic dysfunction–associated steatotic liver disease risk factors in lean participants. Data are presented as odds ratio (OR) and 95% confidence interval (CI). Data were adjusted by sex, age, body mass index (BMI), waist-to-hip ratio, arterial hypertension, type 2 diabetes mellitus (DM), insulin resistance, smoking habit, lipid-lowering drugs use, and previous steroid use. IBD, inflammatory bowel disease.

Figure 5.

Logistic regression analysis of metabolic dysfunction–associated steatotic liver disease risk factors in the lean inflammatory bowel disease (IBD) group. Data are presented as odds ratio (OR) and 95% confidence interval (CI). Data were adjusted by sex, age, body mass index (BMI), waist-to-hip ratio, arterial hypertension, type 2 diabetes mellitus (DM), insulin resistance, smoking habit, lipid-lowering drugs use, and previous steroid use.