Metabolic Dysfunction–Associated Steatotic Liver Disease Linked With CRC

Patients with metabolic dysfunction–associated steatotic liver disease (MASLD) were at an increased risk of colorectal cancer (CRC) and colorectal adenomas (CRAs) according to a meta-analysis published in Frontiers in Oncology.¹ Further understanding of the link between MASLD and CRC/CRA should be the focus of future studies.

MASLD, previously known as nonalcoholic fatty liver disease (FLD), is the most common chronic liver disease in the world, with up to 30% of adults affected globally. CRC is the third most common cancer with the second highest mortality rate² and is often caused by CRAs. MASLD and CRC/CRAs have common risk factors to their development, including resistance to insulin and metabolic syndrome, but the link between them has not been extensively studied. This meta-analysis aimed to establish the association between the risk of both MASLD and CRC/CRAs.

This analysis used cohort studies as the basis of the review. PubMed, Web of Science, and Embase were studied from the time of their creation through December 2023. Cohort studies that assessed the relationship between MASLD and CRC/CRsA had an exposure factor of MASLD; provided HRs, relative risks (RRs), ORs, or incidence rate ratios (IRRs); or had an outcome of developing either CRC/CRAs or MASLD included in the review. Studies were excluded if they were duplicates, were cross-sectional or case-control analyses, did not contain relevant data, or did not have a control group. All data were extracted for the review, including study location, duration of the follow-up, how MASLD or CRC/CRAs were diagnosed, and the HR, RR, OR, and IRR.

MASLD could increase the risk of colorectal cancer in patients | Image credit: New Africa - stock.adobe.com

Fifteen studies were included in the review, and they covered 9,958,412 participants. The studies were published between 2012 and 2023 with most of the studies (11) coming from Asia, 3 from Europe, and 1 from North America. Confirming FLD was done differently in the studies, with 7 using ultrasonography (USG), 2 using fatty liver index (FLI), and 4 using International Classification of Diseases (ICD) codes.

There were 13 studies that included 9,955,867 participants that focused on the association between MASLD and developing CRC. A higher risk of incident CRC was found in patients with MASLD (HR, 1.25; 95% CI, 1.15-1.36). When USG (HR, 1.45; 95% CI, 1.07-1.97), FLI (HR, 1.18; 95% CI, 1.15-1.22), and ICD codes (HR, 1.52; 95% CI, 1.21-1.92) were used to confirm FLD, MASLD was associated with an increased risk of CRC; liver biopsy was not associated with CRC in patients with MASLD.

A significant association was found between MASLD and the risk of CRA in the 4 cohort studies that assessed the relationship (HR, 1.38; 95% CI, 1.17-1.64). The overall findings were not affected by the sensitivity analysis.

There were some limitations to this study. The confounding factors found in the different studies were not consistent, with some studies not addressing common risk factors. Also, the effect of severity and treatment of MASLD could not be assessed due to lack of information, and there was a moderate to high degree of heterogeneity in the studies included; only 1 study used liver biopsy to diagnose MASLD. There also could be some subjectivity in the quality assessment of the studies, and most of the studies included were from Asia.

An increased risk of CRC/CRAs was found in patients with MASLD. Future studies should focus on confirming these findings in patients from Europe and North America, and better understanding of the relationship between the 2 diseases.

References

1. Zhao JF, Zhou BG, Lv Y, et al. Association between metabolic dysfunction-associated steatotic liver disease and risk of colorectal cancer or colorectal adenoma: an updated meta-analysis of cohort studies. Front Oncol. 2024;14:1368965. doi:10.3389/fonc.2024.1368965

2. Key statistics for colorectal cancer. American Cancer Society. Updated January 29, 2024. Accessed July 24, 2024. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html