Abstract
Abstract Background IBD is characterized by a systemic inflammatory state. The dysbiosis found in these patients may lead to a possible increased risk of MASLD through intestinal bacterial translocation, and increased entry of lipopolysaccharides, free fatty acids and other toxins directly to the liver via the portal vein. The objective of this study is to evaluate the prevalence of MASLD in patients with IBD and the factors associated with this condition. Methods The presence of MASLD was based on the presence of hepatic steatosis associated with at least 1 metabolic criterion, and the exclusion of other liver disease in outpatients with IBD. Patients with BMI < 18.0 or BMI > 40 kg/m2, alcohol use or prednisone use > 20 mg/d were excluded. Results A total of 179 IBD patients were included: 95 with ulcerative colitis (UC) (53.1%) and 84 with Crohn’s disease (CD) (46.9%). The mean age was 45.1±14.4 years, 65.4% were female, and the mean disease duration was 10.9±7.8 years. Clinical activity was observed in 40. 45% and endoscopic activity in 49.70%. Biological therapy was used by 35.8% of UC patients and 71.4% of CD patients. In total, 72 (40.22%) patients had MASLD; 4 (2.23%) had MASH and 9 (5.02%) had liver fibrosis. Patients with MASLD were significantly older (48.3±12.6 vs. 43.0±15.2 years, p=0.0148) and had a higher prevalence of comorbidities, including diabetes (20.8% vs. 6.5%, p=0.0043), hypertension (30.6% vs. 12.2%, p=0.0023), dyslipidemia (25.0% vs. 7.5%, p=0.0011), and insulin resistance (61.4% vs. 19.4%, p<0.0001). MASLD patients also had higher BMI (29.1±3.6 vs. 24.5±4.0, p<0.0001), elevated blood glucose (100.1±23.8 vs. 87.3±17.9, p<0.0001), and triglycerides (186.9±107.5 vs. 117.6±59.9, p<0.0001), along with lower HDL-cholesterol (51.0±16.6 vs. 57.0±15.3, p=0.0098). Laboratory parameters including hematocrit (p=0.0035), hemoglobin (p=0.003), creatinine (p=0.017), CRP (p=0.0444), AST (p=0.0033), ALT (p<0.0001), gamma-GT (p<0.0001), and ferritin (p=0.0003) were also elevated in MASLD patients. There was no difference in disease characteristics such as extent of the inflammatory process, clinical (p=0.6131) or endoscopic activity (p=0.3877) or use of medications (p>0.05) between the groups. Conclusion We found a high prevalence of MASLD in patients with IBD, with a strong association to metabolic risk factors rather than disease activity. Therefore, early identification and management of metabolic syndrome and MASLD are critical to preventing liver disease progression and related complications in IBD patients.
Published Version
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