P0232 Advanced steatotic liver disease and visceral adiposity are independently associated with digestive cancer prevalence in inflammatory bowel disease: a multicentre cross-sectional study

Abstract Background Patients with inflammatory bowel disease (IBD) present an increased risk of metabolic dysfunction–associated steatotic liver disease (MASLD) and gastrointestinal cancers. Central obesity and advanced steatotic liver disease (SLD) may synergistically promote carcinogenesis. We aimed to assess whether visceral adiposity (waist-to-height ratio, WHtR) and advanced SLD are associated with cancer prevalence in IBD. Methods Multicentre cross-sectional study including IBD patients who underwent prospective hepatic assessment by transient elastography. Cancer history (overall, digestive, and hormone-related) was retrospectively collected. SLD was defined as a controlled attenuation parameter (CAP) ≥ 248 dB/m, while advanced SLD was defined as liver stiffness measurement (LSM) > 8 kPa. MASLD was defined as the presence of hepatic steatosis together with at least one cardiometabolic risk factor; advanced MASLD corresponded to MASLD with LSM > 8 kPa. Associations between hepatic/metabolic parameters and cancer prevalence were explored using logistic and Firth’s penalized regression, adjusted for age and sex, and stratified by age and age at IBD diagnosis. Results A total of 1,508 patients were included (712 Crohn’s disease, 796 ulcerative colitis), mean age 50.7 ± 13.1 years, 50.6% women. SLD and advanced SLD were diagnosed in 237 (15.7%) and 83 (5.5%) patients, respectively; MASLD and advanced MASLD in 516 (34.2%) and 73 (4.8%). Overall cancer prevalence was 8.4%, and digestive cancer 0.7%. Advanced MASLD was significantly associated with digestive cancer (crude OR 7.35; p = 0.004; adjusted OR 4.93 [1.24–19.71]; p = 0.024). A NAFLD fibrosis score < –1.455 was protective for digestive cancer (OR 0.17 [0.02–0.80]; p = 0.023) and for overall cancer in late IBD diagnosis (OR 0.52 [0.28–0.96]; p = 0.038). FIB-4 < 1.3 protected against overall cancer in early-diagnosis patients (OR 0.34 [0.15–0.77]; p = 0.010). WHtR correlated with overall cancer (p < 0.0001) and with digestive cancer in patients > 60 years (p = 0.062) or IBD diagnosed > 40 years (p = 0.042). Conclusion In IBD, advanced MASLD and increased visceral adiposity (high WHtR) were independently associated with digestive cancer prevalence, supporting a metabolic–oncologic interplay between hepatic and visceral fat pathways. These findings warrant validation in longitudinal studies. References: 1. Rodriguez-Duque JC, Calleja JL, Iruzubieta P, Hernández-Conde M, Rivas-Rivas C, Vera MI, et al. Increased risk of MAFLD and liver fibrosis in inflammatory bowel disease independent of classic metabolic risk factors. Clin Gastroenterol Hepatol. 2023;21(2):406–414.e7. doi:10.1016/j.cgh.2022.01.039. 2. Martínez-Domínguez SJ, García-Mateo S, Gargallo-Puyuelo CJ, Gallego-Llera B, Callau P, Mendi C, et al. Inflammatory bowel disease is an independent risk factor for metabolic dysfunction–associated steatotic liver disease in lean individuals. Inflamm Bowel Dis. 2023. doi:10.1093/ibd/izad175. 3. Zhang Y, Zhou BG, Zhan JD, Du BB. Association between metabolic dysfunction-associated steatotic liver disease and risk of incident pancreatic cancer: A systematic review and meta-analysis of cohort studies. Front Oncol. 2024;14:1366195. doi:10.3389/fonc.2024.1366195. 4. Peng Y, Wang P, Liu F, Wang X, Si C, Gong J, et al. Metabolic dysfunction-associated steatotic liver disease and cancer risk: A cohort study. Diabetes Obes Metab. 2025;27(4):1940–9. doi:10.1111/dom.16186. Conflict of interest: Mrs. Rivas, Coral: No conflict of interest García Mateo, Sandra: No conflict of interest Alonso Fernández, Sara: No conflict of interest Echavarría, Victor José: No conflict of interest Martínez-Domínguez, Samuel Jesús: No conflict of interest García-Mateo, Sergio: No conflict of interest Rivero Tirado, Montserrat: No conflict of interest Escuín, María: No conflict of interest García, María José: No conflict of interest Gallego, Beatriz: No conflict of interest Castro Senosiain, Beatriz: No conflict of interest Alfambra, Erika: No conflict of interest Rodríguez-Duque, Juan Carlos: No conflict of interest Gargallo-Puyuelo, Carla: No conflict of interest Rodríguez Benjumeda, Gerardo: No conflict of interest Ruiz Saez, Henar: No conflict of interest Pascual-Mato, Marta: No conflict of interest Arias-Loste, María Teresa: No conflict of interest Gomollón Garcia, Fernando: Grant: MSD, Abbvie, Janssen Personal Fees: Janssen, Abbvie, Takeda Non-financial Support: Janssen, Takeda, Falk,Pfizer