Colorectal cancer in metabolic dysfunction-associated steatotic liver disease: an international Delphi consensus statement
Year: 2026
Type: article
Abstract: BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide. Epidemiological evidence indicates that MASLD is associated with an increased risk of developing colorectal cancer (CRC). MASLD and CRC share many common risk factors and pathophysiological mechanisms, but an optimal strategy for identifying and managing CRC risk in individuals with MASLD remains lacking. OBJECTIVE: This study aimed to achieve consensus on the risk of CRC in individuals with MASLD. DESIGN: A Delphi survey was conducted by a multidisciplinary panel of 35 international experts from diverse medical fields across Asia, Europe, North America, South America, Oceania and Africa. Experts evaluated 17 statements across three domains: epidemiology, pathogenesis and management. RESULTS: Consensus was achieved on all 17 statements. MASLD is associated with an increased risk of CRC, and metabolic burden further increases this risk. Furthermore, the severity of MASLD is associated with worse outcomes in patients with MASLD and CRC. The gut-liver axis and gut dysbiosis play key roles in the development of MASLD and CRC, while leptin and adiponectin may also be involved. Weight loss with lifestyle interventions, early CRC screening, bariatric surgery and use of GLP-1 receptor agonists are highlighted as potential risk-reduction strategies. CONCLUSION: The expert panel emphasises the need for greater clinical vigilance for CRC among individuals with MASLD. This consensus supports a paradigm shift towards earlier, risk-adapted screening and integrated metabolic management to reduce the burden of CRC in the MASLD population.
Source: Gut
Authors: Chu-Tian Wu, Giovanni Targher, Christopher D Byrne, Zobair M Younossi, Matthew J Armstrong, Hung N Luu, Cosmas Rinaldi A Lesmana, Vinod K Rustgi, James A Thomas, Koji Okabayashi, Jonathan Wei Jie Lee, Hashem B El-Serag, Won Kim, Hai-Jun Zhang, Amedeo Lonardo, Matheus Souza, Elena S George, Wah Yang, Yusuf Yilmaz, George Papatheodoridis, Silvia Sookoian, Manuel Romero-Gómez, Giada Sebastiani, Jörn M Schattenberg, Mohamed El-Kassas, Wah-Kheong Chan, Ponsiano Ocama, Monica Lupșor-Platon, Nilanka Perera, Khalid Alswat, Nahum Méndez-Sánchez, Vincent Wai-Sun Wong, Jin Chai, Herbert Tilg, Joseph Jao-Yiu Sung, Ming-Hua Zheng
Institutions: Guangzhou Medical University, University of Verona, Ospedale Sacro Cuore Don Calabria, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, University of Southampton, Inova Health System, Center for Outcomes Research in Liver Diseases, Queen Elizabeth Hospital Birmingham, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Houston Methodist, University of Pittsburgh, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, University of Indonesia, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Rutgers, The State University of New Jersey, The University of Queensland, Princess Alexandra Hospital, Keio University, National University of Singapore, National University Hospital, Institute for Health Innovation & Technology, Baylor College of Medicine, Seoul National University, Seoul Metropolitan Government, SNUH SMG-SNU Boramae Medical Center, Zhongda Hospital Southeast University, Southeast University, Azienda Ospedaliero-Universitaria di Modena, Universidade Federal do Rio de Janeiro, Deakin University, First Affiliated Hospital of Jinan University, Recep Tayyip Erdoğan University, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Maimónides, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, McGill University Health Centre, Royal Victoria Hospital, Saarland University, Applied Science Private University, Helwan University, University of Malaya, Makerere University, Iuliu Hațieganu University of Medicine and Pharmacy, Institutul Regional de Gastroenterologie Prof. Dr. Octavian Fodor, University of Sri Jayewardenepura, King Saud University, Hospital Médica Sur, Universidad Nacional Autónoma de México, Chinese University of Hong Kong, Army Medical University, Southwest Hospital, Innsbruck Medical University, Universität Innsbruck, Nanyang Technological University, First Affiliated Hospital of Wenzhou Medical University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7125488643