Advanced colorectal neoplasia and colorectal cancer in metabolic dysfunction-associated steatotic liver disease

Although metabolic-associated fatty liver disease (MASLD) is linked to an increased prevalence of colorectal cancer (CRC), large-scale incidence data on its association with advanced colorectal neoplasia (ACN) and CRC are lacking.

This retrospective longitudinal study aims to evaluate the association between MASLD and the incidence of ACN and CRC.

Three populations were used from a large-scale health check-up cohort: 127,344 individuals for initial colonoscopy screening (prevalence of ACN and CRC), 77,316 individuals with clinical follow-up (incidence of CRC), and 25,694 individuals with follow-up colonoscopy (incidence of ACN and CRC). Cox regression and Kaplan-Meier analysis were performed, stratified by liver fibrosis severity using the Fibrosis-4 index.

Among 127,344 participants undergoing colonoscopy, 8.3% had ACN and 3.4% had CRC. MASLD was associated with a higher prevalence of both (10.7% vs. 7.0%, P < 0.001; 3.9% vs. 3.1%, P < 0.001) and increased risk of ACN (OR = 1.55, 95% CI: 1.47-1.63) and CRC (OR = 1.41, 95% CI: 1.31-1.53). Among 77,316 individuals followed for a median of 4.0 years, MASLD was associated with a higher CRC incidence (1.9 vs. 1.1 per 1,000 person-years; HR = 2.11, 95% CI: 1.71-2.61). In 25,694 individuals with follow-up colonoscopy, MASLD increased the risk of ACN (HR = 1.89, 95% CI: 1.61-2.21) and CRC (HR = 1.64, 95% CI: 1.17-2.30). Across all analyses, more severe fibrosis was associated with progressively higher risks. Sensitivity and subgroup analyses further confirmed the robustness of the outcomes.

MASLD is associated with a higher prevalence and incidence of CRC and ACN, with risks increasing stepwise with liver fibrosis severity.