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The following is a summary of “Colorectal cancer incidence in steatotic liver disease (MASLD, MetALD, and ALD),” published in the January 2025 issue of Clinical Gastroenterology and Hepatology by Kimura et al.

Obesity and alcohol consumption are well-established risk factors for colorectal cancer (CRC), yet their combined impact through steatotic liver disease (SLD) subtypes remains unclear. A newly proposed classification framework for SLD distinguishes among metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD). However, the differential risk of CRC across these SLD subgroups has not been previously elucidated. 

This nationwide, population-based cohort study aimed to evaluate the incidence of CRC in patients with MASLD, MetALD, and ALD, using a large-scale dataset to assess the relative CRC risk across these liver disease subtypes. A total of 1,497,813 patients diagnosed with MASLD, MetALD, or ALD were included, along with 4,885,536 individuals without known liver disease serving as a comparison group. The primary outcome was the incidence of CRC, with risk assessments adjusted for key confounders, including age, sex, smoking status, frequency of colorectal examinations, diabetes mellitus, dyslipidemia, hypertension, and medication use. The cumulative CRC incidence at 5 and 10 years was 0.22% and 0.48% for MASLD, 0.32% and 0.73% for MetALD, 0.43% and 0.97% for ALD, and 0.15% and 0.31% for the comparison group, respectively. 

Among the SLD subgroups, ALD was associated with the highest cumulative CRC incidence, significantly exceeding the rates observed in MetALD, MASLD, and the non-SLD comparison group (P< 0.001). Adjusted HR analyses, using the comparison group as the reference, demonstrated that ALD conferred the greatest CRC risk (HR: 1.73, 95% CI: 1.59–1.87), followed by MetALD (HR: 1.36, 95% CI: 1.28–1.45) and MASLD (HR: 1.28, 95% CI: 1.22–1.35). These findings underscore a significant variation in CRC risk among SLD subtypes, with alcohol consumption playing a key role in exacerbating CRC susceptibility. Given the growing prevalence of SLD globally, these results highlight the need for targeted CRC screening strategies tailored to patients with SLD, particularly those with ALD and MetALD, to facilitate early detection and improve long-term clinical outcomes.

Source: cghjournal.org/article/S1542-3565(25)00074-6/abstract