From gut to liver: Exploring the relationship between inflammatory bowel disease and metabolic dysfunction-associated steatotic liver disease

Table 1 Factors associated with the development of metabolic dysfunction-associated steatotic liver disease in patients with inflammatory bowel disease

Associated factor	Evidence/commentary
Obesity	Observed even in patients with IBD in clinical remission
Insulin resistance	Central mechanism in the pathophysiology of MASLD, aggravated by chronic inflammation
Prolonged use of corticosteroids	Associated with changes in lipid metabolism and fat distribution
Metabolic syndrome	High prevalence in patients with IBD and MASLD
Chronic low-grade inflammation	May contribute to liver changes even with IBD in remission
Intestinal dysbiosis	Affects hepatic homeostasis via the gut–liver axis
Previous malnutrition with rapid refeeding	Can lead to hepatic steatosis due to liver overload
Sedentary lifestyle	Reduced energy expenditure contributes to the accumulation of liver fat
Use of methotrexate or azathioprine	Drugs with potential hepatotoxic impact

IBD: Inflammatory bowel disease; MASLD: Metabolic dysfunction-associated steatotic liver disease.

Table 2 Changes in gut microbiota and the risk of metabolic dysfunction-associated steatotic liver disease in patients with inflammatory bowel disease

Changes in gut microbiota	Evidence/commentary
Intestinal dysbiosis	Imbalance between beneficial and pathogenic microbiota can lead to liver inflammation and the development of MASLD
Decrease in Firmicutes and increase in Bacteroidetes	Common changes in patients with inflammatory bowel disease, associated with an increased risk of hepatic steatosis
Decrease in Lactobacillus and Bifidobacterium	Beneficial microorganisms that play a role in intestinal protection, the reduction of which can intensify liver inflammation
Increase in Proteobacteria	Species of the genus Proteobacteria associated with intestinal and hepatic inflammation, promoting the risk of MASLD
Increase in E. coli	The proliferation of E. coli associated with chronic inflammation can aggravate the risk of fat accumulation in the liver
Changes in the production of SCFAs	Dysbiosis leads to lower production of SCFAs, molecules that help regulate liver and intestinal function
Alteration of the intestine-liver axis	Altered microbiota may influence liver function via immune and nervous axes, exacerbating the risk of MASLD
Pro-inflammatory microbiota	The predominance of pro-inflammatory species, such as Enterococcus and Streptococcus, is associated with an increased risk of MASLD

E. coli: Escherichia coli; MASLD: Metabolic dysfunction-associated steatotic liver disease; SCFAs: Short-chain fatty acids.