THE ASSOCIATION BETWEEN THE NEW DEFINITION OF METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE (MASLD) AND THE INCIDENCE OF METACHRONOUS COLORECTAL NEOPLASM AFTER POLYPECTOMY

Introduction & Aim:
Metachronous colorectal neoplasms (meta-CRN) and advanced neoplasms (meta-ACRN) occur more frequently in subjects with metabolic dysfunction after polypectomy, and exercise has been associated with a reduced risk (Chang et al., Dig Endosc 2022; DDW 2023). The new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) comprises patients with varying degrees of metabolic dysfunction, whereas its association with meta-CRN is unknown.
Material & Method:
Average-risk subjects aged ≥ 40 years who underwent screening and surveillance colonoscopy between January 2009 and December 2021 were retrospectively enrolled. The baseline and follow-up statuses of metabolic profiles of each subject were obtained on the date of screening and surveillance colonoscopy, respectively. Hepatic steatosis was diagnosed by abdominal ultrasound on the date of colonoscopy. MASLD was defined as those who had hepatic steatosis and at least one of the following cardiometabolic risk factors: overweight or central obesity; impaired fasting glucose; hypertension; hypertriglyceridemia or low serum high-density lipoprotein (Rinella ME et al., Hepatology 2023). The baseline severity of metabolic dysfunction was defined by the number of factors each subject had on the date of screening, and the improvement of such dysfunction was defined as those who had a reduced number of factors at the surveillance day. The risk of meta-CRN was analyzed by Kaplan-Meier analysis. Cox regression models were constructed for multivariate analysis.
Result:
A total of 2,333 subjects fulfilling the definition of MASLD and having at least one adenoma on screening colonoscopy were enrolled in this study. There were 760 subjects with mild (1-2 factors), 758 with moderate (3 factors), and 815 with severe (4-5 factors) metabolic dysfunction. During a mean follow-up time of 4.0 years, 539 and 215 subjects achieved an improved metabolic status with one and ≥2 risk factors reduction, whereas the remaining 1579 subjects showed no metabolic dysfunction improvement. The severity of baseline metabolic dysfunction was associated with a higher incidence of meta-CRN (Figure). In the multivariable analysis, each one-item increment was associated with a 6% increase in meta-CRN risk (adjusted hazard ratio (aHR): 1.06; 95% confidence interval (CI) = 1.01-1.12). On the other hand, one cardiometabolic factor reduction over time was associated with a 42% risk reduction of meta-ACRN, while ≥2 cardiometabolic factors reduction was associated with 39% and 70% risk reduction of meta-CRN and meta-ACRN (Table).
Conclusion:
The severity of metabolic dysfunction in MASLD patients was positively associated with the risk of meta-CRN after polypectomy. Improved metabolic dysfunction during the surveillance interval is associated with a reduced risk of meta-CRN and meta-ACRN in a dose-response manner.