Association between metabolic dysfunction-associated steatotic liver disease, lean metabolic dysfunction-associated...

Nonalcoholic fatty liver disease (NAFLD) is linked to colorectal cancer and adenoma. Lean NAFLD is associated with a higher colorectal cancer risk than non-lean NAFLD. NAFLD was modified as metabolic dysfunction-associated steatotic liver disease (MASLD). Certain adenoma features carry a high risk of metachronous lesions requiring early colonoscopy follow-up. The association between MASLD, lean MASLD, and colorectal adenomas with these features is unclear and is assessed in this study.

This cross-sectional study included patients greater than or equal to 18 years undergoing health checkups at Fu Jen Catholic University Hospital, Taiwan, between 2018 and 2023. Data collected included cardiometabolic markers, colonoscopy, liver ultrasonography, and a questionnaire. MASLD was hepatic steatosis plus greater than or equal to one cardiometabolic risk factor. Polyps with high risk of metachronous lesions were defined as having greater than or equal to one of the following features: greater than or equal to five adenomas, any adenoma greater than or equal to 10 mm, villous histology, high-grade dysplasia, or traditional serrated adenoma. Logistic regression was used to assess associations between patient groups and colorectal adenomas, adjusting for confounders.

Among 5616 patients, 45.0% had MASLD, 2.4% hepatic steatosis without cardiometabolic abnormality, and 52.6% normal liver; 11.6% of MASLD were lean. Logistic regressions confirmed that MASLD was associated with colorectal adenomas [adjusted odds ratio (aOR) = 1.32] and adenomas with high-risk features (aOR = 1.46), all P values less than 0.05. Among patients with MASLD, lean MASLD was not associated with either outcome.

MASLD is associated with an increased prevalence of colorectal adenomas, including those with a high risk of metachronous lesions. Lean MASLD patients did not show higher adenoma rates.