Retrospective cohort study of metabolic optimization and risk of metachronous advanced colorectal neoplasia in patients with MASLD

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk for colorectal neoplasia. A retrospective cohort study at National Taiwan University Hospital (Taipei, Taiwan) investigated whether dynamic reduction of cardiometabolic risk factors(CMRFs) can prevent metachronous advanced colorectal neoplasia (ACRN). The study included patients at least 40 years of age with MASLD who underwent successful removal of at least one colorectal adenoma between 2009 and 2021 and underwent surveillance colonoscopy and had a minimum follow-up of one year. Among 2331 enrolled patients who completed the surveillance protocol, the mean follow-up was 4.0 years (SD 2.5). Reducing CMRF counts during follow-up after polypectomy was associated with decreased metachronous ACRN risk compared with no reduction. This decreased risk was more pronounced among high-risk patients with 5 CMRFs or ACRN at baseline. The authors conclude that these findings suggest that longitudinal metabolic optimization may be a primary prevention strategy against ACRN in patients with MASLD.