Abstract
Whether body mass index (BMI) can meaningfully distinguish inflammatory bowel disease (IBD) patients with concomitant metabolic dysfunction-associated steatotic liver disease (MASLD) was examined in a retrospective hospital series. The analysis covered 400 records from 2023–2024 with verified ulcerative colitis or Crohn’s disease and sufficient information on anthropometry, liver status, and intestinal disease activity. Normal BMI was documented in 118 patients, 176 were overweight, and 106 had obesity. MASLD classification required documented hepatic steatosis in the appropriate cardiometabolic setting; ultrasonography provided the principal evidence of steatosis, while laboratory findings, non-invasive indices, and elastography were considered when available. Ulcerative colitis activity was based on the Mayo Score and Crohn’s disease activity on CDAI. Overall, 181 patients (45.3%) met MASLD criteria. The corresponding frequencies across the three BMI strata were 20.3%, 49.4%, and 66.0% (χ
2
=49.29; p2
=39.45; p<0.001). Relative to normal BMI, the unadjusted odds of MASLD were 3.83-fold higher with overweight (95% CI 2.24-6.55) and 7.62-fold higher with obesity (95% CI 4.17-13.91). Thus, BMI categories identified groups with distinctly different burdens of both MASLD and severe IBD. Because treatment exposure, disease duration, and other covariates were not included in an adjusted model, the observed differences should be interpreted as associations rather than causal effects.