Zhou Yesheng, Yang Zhirong, Liu Si, Xie Sian, Zhang Qian, Zhang Shutian, Zhu Shengtao, Wu Shanshan
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, China.
Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
BMC Gastroenterol. 2025 Aug 11;25(1):576. doi: 10.1186/s12876-025-04165-7.
Despite the increased irritable bowel syndrome (IBS) risk associated with hepatic steatosis demonstrated in prior evidence, it is still unclear whether the newly coined metabolic dysfunction-associated steatotic liver disease (MASLD), could in reverse impact IBS development. We prospectively assessed the association of MASLD, MASLD type and different cardiometabolic risk factors (CMRFs) with incident IBS in a nationwide population-based cohort.
Participants free of IBS at baseline in UK Biobank were included (N = 380,619). MASLD, MASLD type [pure MASLD, MASLD with increased alcohol intake (MetALD)] and CMRFs were defined based on the new criteria in America and Europe. Cox proportional hazard model was used to assess the associated risk of incident IBS.
Overall, 143,857 (37.8%) had MASLD at baseline. During a median 13.2-year follow-up, 7329 incident IBS cases were identified. Compared with normal individuals, MASLD patients had an 11% elevated risk of IBS (HR = 1.11, 95%CI: 1.04-1.20). The increased risk was present in both pure MASLD (HR = 1.12, 1.03-1.21) and MetALD (HR = 1.26, 1.09-1.45) patients. Moreover, a substantially greater risk of IBS was observed as the number of CMRFs increased in MASLD patients (P < 0.001), with 16% and 30% higher risk in MASLD with 3 CMRFs (HR = 1.16, 1.06-1.27) and ≥ 4 CMRFs (HR = 1.30, 1.17-1.43) patients. Additionally, risk of IBS was significantly higher among MASLD patients with a certain CMRF [overweight/obesity (HR = 1.14, 1.05-1.23), dysglycemia (HR = 1.15, 1.05-1.27) and dyslipidemia (HR = 1.18, 1.09-1.28)] versus normal individuals, respectively. Further sensitivity analysis and subgroup analysis indicated similar results.
MASLD, either pure MASLD or MetALD, was associated with an increased risk of incident IBS, with greater risk with more cardiometabolic risk factors, suggesting management of MASLD may help prevent IBS.
尽管先前的证据表明肝脂肪变性与肠易激综合征（IBS）风险增加有关，但新提出的代谢功能障碍相关脂肪性肝病（MASLD）是否会反过来影响IBS的发展仍不清楚。我们在全国范围内基于人群的队列中前瞻性地评估了MASLD、MASLD类型和不同的心血管代谢危险因素（CMRFs）与新发IBS的关联。
纳入英国生物银行中基线时无IBS的参与者（N = 380,619）。根据美国和欧洲的新标准定义MASLD、MASLD类型[单纯MASLD、酒精摄入增加的MASLD（MetALD）]和CMRFs。采用Cox比例风险模型评估新发IBS的相关风险。
总体而言，143,857名（37.8%）参与者在基线时患有MASLD。在中位13.2年的随访期间，共识别出7329例新发IBS病例。与正常个体相比，MASLD患者患IBS的风险升高了11%（HR = 1.11，95%CI：1.04 - 1.20）。单纯MASLD患者（HR = 1.12，1.03 - 1.21）和MetALD患者（HR = 1.26，1.09 - 1.45）的风险均有所增加。此外，随着MASLD患者中CMRFs数量的增加，患IBS的风险显著升高（P < 0.001），有3个CMRFs的MASLD患者（HR = 1.16，1.06 - 1.27）和≥4个CMRFs的MASLD患者（HR = 1.30，1.17 - 1.43）患IBS的风险分别高出16%和30%。此外，患有特定CMRFs的MASLD患者[超重/肥胖（HR = 1.14，1.05 - 1.23）、血糖异常（HR = 1.15，1.05 - 1.27）和血脂异常（HR = 1.18，1.09 - 1.28）]患IBS的风险分别显著高于正常个体。进一步的敏感性分析和亚组分析表明结果相似。
MASLD，无论是单纯MASLD还是MetALD，都与新发IBS风险增加有关，心血管代谢危险因素越多风险越高，这表明对MASLD的管理可能有助于预防IBS。
