Long-Term Risk of Inflammatory Bowel Disease With MASLD: A Large-Scale Prospective Cohort Study in UK Biobank

Area of Science:

• Hepatology and Gastroenterology
• Metabolic Disorders
• Epidemiology

Background:

• Global epidemics of metabolic dysfunction-associated steatotic liver disease (MASLD) and inflammatory bowel disease (IBD) are worsening.
• Understanding the link between MASLD and IBD is crucial for public health.
• Investigating the role of cardiometabolic risk factors (CMRFs) in this association is important.

Purpose of the Study:

• To prospectively examine the association between MASLD, its subtypes, and CMRFs with the long-term risk of incident IBD.
• To analyze the risk for specific IBD types, ulcerative colitis (UC) and Crohn's disease (CD).
• To determine if the number of CMRFs influences the risk of developing IBD.

Main Methods:

• Utilized UK Biobank data, including over 400,000 participants.
• Defined MASLD using fatty liver index and at least one CMRF, adhering to AASLD/EASL criteria.
• Classified MASLD into pure MASLD and MetALD (MASLD with increased alcohol intake).
• Employed multivariable Cox regression to analyze associations with incident IBD over a median 13.0-year follow-up.

Main Results:

• 37.6% of participants had MASLD at baseline.
• MASLD was significantly associated with a higher risk of incident IBD (HR=1.39), UC (HR=1.34), and CD (HR=1.51).
• Both pure MASLD and MetALD showed increased IBD risk.
• The risk of incident IBD progressively increased with a higher number of CMRFs (p_trend < 0.001).

Conclusions:

• MASLD, encompassing both pure MASLD and MetALD, is associated with an elevated risk of developing IBD, including UC and CD.
• The presence of multiple CMRFs amplifies the risk of incident IBD.
• These findings highlight the interconnectedness of metabolic health and gastrointestinal inflammatory conditions.