New Meta-Analysis Highlights Burden of MASLD Among IBD Patients
Study Findings
In this updated global meta-analysis, researchers examined 64 studies encompassing over 1.5 million patients with IBD to estimate the prevalence of MASLD (previously nonalcoholic fatty liver disease or NAFLD) and identify associated demographic, clinical, and pharmacologic factors. The pooled analysis found that approximately 1 in 4 patients with IBD has MASLD, reaffirming the condition as a common extraintestinal comorbidity across diverse geographic regions.
Prevalence estimates were broadly consistent with earlier reports, which have observed rates around 24–32% in IBD cohorts. Factors linked with higher MASLD risk in IBD included traditional metabolic risk factors such as obesity and diabetes, older age, and possibly longer disease duration. One hypothesis is that chronic intestinal inflammation associated with IBD and metabolic dysregulation may underlie the increased susceptibility of IBD patients to develop MASLD.
The study underscores notable geographic variability in MASLD prevalence among IBD patients, reflecting differences in population metabolic profiles, diagnostic approaches, and healthcare access. Although the authors note heterogeneity across included studies, the large sample size strengthens confidence in the global prevalence estimate.
Clinical Implications
These findings have several clinical implications for gastroenterology practice and hepatology care. First, MASLD should be actively considered in the routine assessment of patients with IBD, particularly those with metabolic risk factors who may be asymptomatic for liver disease. Early detection is crucial, as MASLD can progress to steatohepatitis, fibrosis, and cirrhosis if unrecognized and unmanaged.
For clinicians treating IBD in North America, Europe, Asia, and other regions, integrating liver imaging, including ultrasound and elastography, and liver enzyme monitoring into longitudinal care protocols may facilitate earlier identification of hepatic steatosis. Evidence suggests that metabolic risk stratification—accounting for BMI, dyslipidemia, and glucose intolerance—can help refine MASLD screening strategies in this population.
Moreover, these data reinforce the importance of multidisciplinary management, involving gastroenterologists, hepatologists, nutritionists, and primary care providers, to address both intestinal inflammation and metabolic comorbidities. Tailored lifestyle interventions, optimized IBD therapy, and careful monitoring of liver health may improve overall outcomes. Regular communication between specialties could enhance detection and guide appropriate referrals for patients at elevated risk.
Reference:
Rao NK, Ghodous S, Gurram A, et al. Prevalence and associated factors of nonalcoholic fatty liver disease in patients with inflammatory bowel disease: an updated global systematic review and meta-analysis of over 1.5 million individuals. Inflamm Bowel Dis. 2026;32(2):350-374. DOI:10.1093/ibd/izaf226.
