Metabolic syndrome and its individual components but not MASLD are associated with advanced fibrosis in primary biliary cholangitis

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Background: The degree of coincidence and interaction between primary biliary cholangitis (PBC) on the one hand and metabolic syndrome (MetS) or metabolic dysfunction-associated steatotic liver disease (MASLD) on the other is unknown. Objectives: The aim of the study was to evaluate the associations between MASLD/MetS and PBC, with the focus on liver fibrosis (F). Design: Cross-sectional observational study. Methods: Cross-sectional observational study recruited consecutive patients treated for PBC prospectively from a single tertiary center. The control group was sampled, matched for age and sex, from the general population obtained from nation wide SIRIUS database, which aims to screen the general population for liver disease. Liver stiffness as a surrogate marker of liver fibrosis was the primary outcome, while achieving complete biochemical response (CBR) was a secondary outcome of our research. Results: Prevalence of MASLD was 42.3% in the PBC group and 41.9% in the control group (NS). Prevalence of MetS was 38.9% in PBC and 60.7% in the control group ( p < 0.001). Advanced liver fibrosis was present significantly more often in the PBC group (21.5%), even after stratification by CBR (9.8%), than in age and sex matched general population (2%; p = 0.003). MetS (odds ratio (OR) 4.561, 95% confidence interval (CI): 1.852–11.398) and the number of fulfilled MetS criteria (1.901, 95% CI: 1.239–2.915), but not MASLD (OR 3.956, 95% CI: 0.730–21.422) were associated with advanced fibrosis. Out of individual MetS criteria hyperglycemia/diabetes mellitus had the strongest association with advanced fibrosis, followed by high-density lipoprotein cholesterol criterion. Neither MASLD nor MetS was associated with CBR. Conclusion: Patients with PBC appear to have a lower prevalence of MetS than age and sex matched general population, despite the same prevalence of MASLD in both groups. MetS but not MASLD was associated with the presence of advanced fibrosis in patients with PBC.

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