MASLD Screening and Crohn's Outcomes Highlighted in Two Studies

Any cardiometabolic risk factor, not just diabetes, appears to be enough to justify screening individuals with overweight for metabolic dysfunction-associated steatotic liver disease (MASLD) and advanced fibrosis, according to study findings published in the American Journal of Gastroenterology. In a separate study presented at Digestive Disease Week 2026, patients with Crohn disease and comorbid MASLD had worse clinical outcomes during hospitalization than those without MASLD.

The cross-sectional study used data from the prospective San Diego Liver Study, which included adults with a body mass index (BMI) of at least 25 kg/m2 (or at least 23 kg/m2 for Asian individuals). The analysis focused on 220 individuals aged 40 to 75 years (mean age, 56.8 years; men, 50.9%) with overweight and no/mild alcohol use. Slightly more than half of the cohort (52%) had MASLD, defined by a liver fat content of 5% or more measured by MRI proton density fat fraction (MRI-PDFF), a lack of other liver diseases, and the presence of at least 1 cardiometabolic risk factor. Among those with MASLD, 7% had advanced fibrosis, with a magnetic resonance elastography result of 3.63 kPa or greater.

In a multivariable analysis, the factors most strongly associated with MASLD were hypertriglyceridemia (odds ratio [OR], 3.11; 95% CI, 1.42-6.81) and hypertension (OR, 2.51; 95% CI, 1.21-5.23). Men were less likely than women to have MASLD (OR, 0.51; P = .0487). Low HDL, prediabetes, and type 2 diabetes were not significantly related to MASLD. The researchers noted that 61% of the patients with MASLD did not have diabetes, and using diabetes as the only motivation to screen would have identified only 40.5% of cases, whereas screening individuals with any cardiometabolic risk factors would have identified 93.9% of cases.

The study authors concluded that current guidelines should be expanded to include overweight individuals with any cardiometabolic risk factor, not just diabetes, as candidates for FIB-4 assessment, and that clinicians should maintain a lower threshold for liver disease evaluation in Hispanic patients who are overweight. The study was limited by its use of data from a single center in Southern California.

In the Crohn's disease study, researchers retrospectively analyzed data from the National Inpatient Sample, which included 1,190,530 inpatients with Crohn disease. Patients with comorbid MASLD (n=25,545) had higher rates of the metabolic comorbidities of obesity, hypertension, hyperlipidemia, hypertriglyceridemia, and diabetes compared with those without MASLD (all P < .001). They also had more infectious complications (19.4% vs 16.6%), sepsis (13.6% vs 11.3%), small bowel obstruction (9.8% vs 8.9%), and bleeding complications (3.9% vs 3.3%; all P < .001).

In the multivariable analysis, MASLD increased risk for sepsis (adjusted odds ratio [aOR], 1.261; 95% CI, 1.211-1.313), bleeding complications (aOR, 1.244; 95% CI, 1.163-1.330), infectious complications (aOR, 1.208; 95% CI, 1.094-1.333), and small bowel obstruction (aOR, 1.170; 95% CI, 1.117-1.226). The study authors said these findings suggest that liver health, specifically the presence of MASLD, should be considered an important component of risk stratification in patients with Crohn disease, though the study does not establish causality.