Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to colorectal cancer (CRC), adenoma, and advanced adenoma,(1, 2) although lesion definitions have varied across studies. The 2020 US Multi-Society Task Force (US MSTF) on CRC identified specific adenoma features associated with high risk of metachronous lesions and recommended follow-up colonoscopy within three years(3). To date, no study has assessed the association between MASLD and adenomas with these features.
Lean MASLD, defined by a BMI <25 kg/m² (<23 kg/m² in Asian populations)(4), has been associated with higher risk of CRC than non-lean MASLD in some studies(5), but its relationship with colorectal adenoma remains unclear.
Aims & Methods
This cross-sectional study aimed to assess the prevalence of colorectal adenomas and adenomas with high-risk features requiring follow-up colonoscopy within three years in patients with MASLD and lean MASLD. High-risk features were defined, per the 2020 US MSTF recommendations, as one or more of the following: ≥5 adenomas, any adenoma ≥10 mm, villous histology, high-grade dysplasia, or traditional serrated adenoma.(3)
We included adults undergoing health check-ups at Fu Jen Catholic University Hospital (Taiwan) between April 2018 and December 2023. Data collected included BMI, waist circumference, blood tests, colonoscopy, liver ultrasonography and a structured questionnaire. Patients with regular alcohol intake were excluded. MASLD was defined as hepatic steatosis plus ≥1 cardiometabolic risk factor.(6) Lean MASLD was defined as MASLD with BMI <23 kg/m². Patients with steatosis but no metabolic risk factors were categorised as “other steatotic liver disease (SLD)”; those without steatosis as “normal liver”. Logistic regression was used to assess associations between patient groups and colorectal adenomas, including those with high-risk features, adjusting for age ≥45 years, sex, smoking, and physical activity.
Results
Of 5,616 patients, 2,528 (45.0%) with MASLD, 136 (2.4%) other SLD, and 2,952 (52.6%) normal liver. Lean MASLD accounted for 11.6% of MASLD cases.
MASLD patients were older (median age: 50 vs. 46 vs. 45 years) and more frequently male (64.0% vs. 42.5% vs. 38.2%) compared to the normal liver and other SLD groups.
Within the MASLD group, lean patients were older (53.0 vs. 50.0 years), less frequently male (40.1% vs. 67.1%), and had lower rates of abnormal triglycerides (34.7% vs. 42.3%) and hypertension (16.7% vs. 24.1%) than their non-lean counterparts.
Colorectal adenomas were more prevalent in MASLD patients than in those with normal liver (23.9% vs. 15.7%, p < 0.001) or other SLD (23.9% vs. 16.2%, p = 0.04). Adenomas with high-risk features were also more frequent in MASLD than normal liver (5.1% vs. 3.0%, p < 0.001).
Logistic regressions confirmed that MASLD as independently associated with colorectal adenomas (adjusted odds ratio [aOR] 1.324, 95% confidence interval [CI]: 1.148–1.528, p < 0.001) and adenomas with high-risk features (aOR 1.463, 95% CI: 1.099–1.946, p = 0.009). Among MASLD patients, lean MASLD was not associated with either outcome; however, higher BMI was independently associated with colorectal adenomas (aOR 1.040, 95% CI: 1.014–1.067, p = 0.002).
Conclusion
MASLD is associated with an increased prevalence of colorectal adenomas, including those with high risk of metachronous lesions. Among MASLD patients, lean individuals did not show higher rates of adenoma, while higher BMI may remain an independent risk factor. Further research is warranted to guide individualised CRC screening in MASLD populations.
References
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