Metabolic Optimization and Risk of Metachronous Advanced Colorectal Neoplasia in Patients With MASLD

Area of Science:

• Hepatology and Gastroenterology
• Metabolic Health and Disease Prevention
• Oncology and Cancer Screening

Background:

• Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) face an elevated risk of colorectal neoplasia.
• The impact of dynamic improvements in metabolic health on preventing metachronous advanced colorectal neoplasia (ACRN) remains under investigation.

Purpose of the Study:

• To investigate the association between longitudinal reduction in cardiometabolic risk factors (CMRFs) and the risk of metachronous ACRN in patients with MASLD.

Main Methods:

• Retrospective cohort study involving 2331 patients with MASLD who underwent colonoscopy and had at least one colorectal adenoma removed.
• Analysis focused on changes in the number of CMRFs (abdominal obesity, hypertriglyceridemia, low HDL, hypertension, impaired fasting glucose) between baseline and surveillance.
• Participants were categorized based on CMRF count changes: reduced, increased, or unchanged.

Main Results:

• A reduction in CMRFs was associated with a significantly lower risk of metachronous ACRN (adjusted hazard ratio [AHR], 0.49).
• Reducing at least two CMRFs lowered the risk by approximately 50% compared to those with increased CMRFs.
• Metabolic improvements demonstrated risk reduction even in high-risk subgroups, including those with 5 CMRFs or baseline ACRN.

Conclusions:

• Longitudinal reduction of CMRFs is linked to a decreased risk of metachronous ACRN in patients with MASLD.
• Integrating metabolic optimization strategies with endoscopic surveillance is recommended for primary prevention of ACRN.
• Improving metabolic health represents a crucial, modifiable factor in managing colorectal neoplasia risk for MASLD patients.