Metabolic dysfunction-associated steatotic liver disease in inflammatory bowel disease: prevalence, risk factors, pathophysiological pathways and clinical consequences.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver comorbidity in patients with inflammatory bowel disease (IBD).

Areas covered: This paper outlines common pathophysiological aspects related to MASLD and IBD; describes the epidemiological clues associated with both diseases; analyzes risk factors contributing to MASLD appearance and progression in IBD patients; reviews data on clinical consequences for this population; and provides advice on the management of patients with both conditions.

Expert opinion: IBD itself, especially Crohns' disease, is a risk factor for MASLD and its progression to liver cirrhosis, independent of other cardiometabolic risk factors. Intestine-dependent mechanisms which contribute to MASLD in IBD and interplay with classic metabolic factors include sarcopenia, disease phenotype, duration and activity. Changes in microbiota also contribute to deregulating the gut-liver-axis in these conditions. By contrast, IBD therapies do not seem to play a relevant role in the risk of developing MASLD; and the potential of biologics and novel small molecules on liver changes requires further investigation. MASLD increases comorbidities, impairs clinical outcomes and increases mortality in IBD patients; therefore, early detection of MASLD is a priority in IBD populations. Individualized and integrative management of both MASLD and IBD is required to improve results.