Abstract Background Inflammatory bowel disease (IBD) has been associated with an increased risk of steatotic liver disease (SLD), especially with metabolic dysfunction-associated steatotic liver disease (MASLD). This study assesses the prevalence of SLD and its subtypes in IBD patients and explores their associations with demographic, clinical, laboratory, and radiological features. Methods This prospective study included 178 adult IBD outpatients from the Gastroenterology Division at the University Hospital of Patras, Greece. To date, 139 patients have completed follow-up clinical, laboratory, and imaging assessments to determine the presence of SLD, while liver elastography has been performed in 69 of them. Results Our cohort included 100 patients with Crohn’s disease (CD), 77 with ulcerative colitis (UC), and 1 with unclassified colitis. 107 were male, and the sample’s mean age was 48 years (IQR: 36-61). Among the 139 patients evaluated, 33 (23.7%) were diagnosed with MASLD, 10 (7.2%) with metabolic dysfunction and alcohol-associated liver disease (met-ALD), 3 (2.2%) with alcoholic liver disease, 2 (1.4%) with cryptogenic SLD, 1 (0.7%) with specific etiology SLD, and 90 (64.7%) had no steatotic liver disease (non-SLD). In the univariate analysis, MASLD patients had higher elastography values (p = 0.032), body mass index (BMI) (p 0.001), overall (p 0.001) and central (p = 0.001) obesity, γ-GT levels (p = 0.014), weight (p = 0.021), and higher rates of IBD extraintestinal manifestations (p = 0.009) compared with non-SLD patients. Patients with met-ALD were older (p = 0.013), had a higher age at IBD diagnosis (p = 0.016), greater weight (p = 0.021), and more frequent extraintestinal manifestations (p = 0.029) than non-SLD patients. Also, MASLD patients exhibited higher rates of extraintestinal manifestations than met-ALD patients (p 0.001). In the multivariate analysis, MASLD patients had higher elastography values (p = 0.05, OR = 0.141, 95%CI: 0.02-0.999), greater weight (p = 0.049, OR = 0.586, 95%CI: 0.344-0.998), and a higher likelihood of extraintestinal manifestations (p = 0.03, OR = 0.019, 95%CI: 0.001-0.675) compared with non-SLD patients. Conclusion This study demonstrates that SLD is prevalent among IBD patients, and MASLD may serve as an early indicator of metabolic dysfunction, liver fibrosis risk, and extraintestinal manifestations in IBD. Further research is needed to clarify the interplay between SLD and IBD and to guide early intervention strategies. Conflict of interest: Pastras, Pl: No conflict of interest Bali, Maria: No conflict of interest Papantoniou, Konstantinos: No conflict of interest Tsounis, Efthymios: No conflict of interest Kanaloupitis, Stavros: No conflict of interest Aggeletopoulou, Ioanna: No conflict of interest Geramoutsos, Giorgos: No conflict of interest Sotiropoulos, Christos: No conflict of interest Zisimopoulos, Konstantinos: No conflict of interest Thomopoulos, Konstantinos: No conflict of interest Theocharis, Georgios: No conflict of interest Triantos, Christos: No conflict of interest
Pastras et al. (2026) studied this question.