Metabolic dysfunction-associated fatty liver disease is an independent risk factor for advanced colorectal adenoma or cancer

Abstract

Background Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We investigated whether MAFLD or its respective subtypes were associated with the risk of advanced colorectal neoplasia (ACN), including age-specific associations. Methods This single-centre retrospective study included 21 642 participants who underwent medical health check-ups. Participants were categorised by fatty liver disease presence (NAFLD or MAFLD). Patients with MAFLD were categorised into three subtypes: overweight-MAFLD, lean-MAFLD, and diabetes-MAFLD. The fibrosis-4 index assessed hepatic fibrotic burden. Results Both NAFLD and MAFLD were significantly associated with nonadvanced colorectal neoplasia risk [odds ratio (OR) = 1.19 and 1.34, respectively; P < 0.05]. In contrast, NAFLD was not significantly associated with ACN risk. Multivariate analysis showed that MAFLD was independently associated with increased ACN risk (OR = 1.20, P < 0.05). Among MAFLD subtypes, diabetes-MAFLD alone was independently associated with increased ACN risk (OR = 1.56, P < 0.05). This MAFLD-ACN association was significant only in patients aged less than or equal to 50 years (OR = 2.54 for 30-39 years and OR = 1.43 for 40-49 years, all P < 0.05). High hepatic fibrotic burden (fibrosis-4 greater than or equal to 1.3) was associated with higher ACN risk in MAFLD patients (OR = 1.31, P < 0.05). Conclusion MAFLD was independently associated with an increased risk of ACN; however, this association differed according to age and MAFLD subtype. Patients with MAFLD, especially those with high fibrotic burden, underlying diabetes, or aged less than or equal to 50 years, may benefit from appropriate colorectal cancer screening.