MASLD increases risk of GI tract cancer in patients with diabetes: Study

A new study published in the journal of Nature Scientific Reports showed that metabolic dysfunction-associated steatotic liver disease (MASLD) decreased the risk of esophageal cancer but increased the risk of stomach, colorectal, and biliary cancers in diabetics. The correlation was stronger as the risk of hepatic steatosis increased. In non-drinkers, the association was more widespread across the GI tract (apart from esophageal cancer), while in modest drinkers, it was restricted to the stomach, colorectal, and biliary sites.

Diabetic patients are more likely to develop alcohol-related steatotic liver disease (SLD) and metabolic diseases, which can raise the risk of gastrointestinal cancer. To create preventative measures and enhance long-term results in this susceptible group, it is essential to comprehend how SLD contributes to carcinogenesis in diabetics. Thus, this study examined the relationship between the incidence of 5 main GI tract malignancies in a large-scale diabetic cohort and recently characterized MASLD and alcohol-related SLD.

4 subgroups were identified from a statewide cohort of 2,616,828 diabetics covered by the Korean National Health Insurance Service between 2015 and 2016: no steatosis (group 1), MASLD alone (group 2), MASLD with high alcohol consumption (group 3), and alcoholic liver disease (group 4). Using cutoff values of 30 and 60, this research evaluated the risk of hepatic steatosis using the fatty liver index.

Up to 2022, this study examined the prevalence of esophagus, stomach, colorectal, biliary, and pancreatic cancers. The adjusted hazard ratios [95% confidence interval] were 1.10 [1.06–1.13], 1.13 [1.10–1.16], 1.10 [1.05–1.16], and 0.88 [0.79–0.97], respectively, for stomach, colorectal, and biliary cancers were higher in group 2 than in group 1 (reference).

In non-drinkers, the probability of hepatic steatosis was strongly connected with all gastrointestinal tract malignancies except esophageal cancer; in light drinkers, it was only significantly correlated with stomach, colorectal, and biliary cancers (ptrend < 0.001). These results emphasize the significance of closely evaluating the risk of gastrointestinal tract cancer in those with metabolic syndrome, diabetes, or steatotic liver disease.

Overall, an increased risk of gastrointestinal tract cancer is linked to MASLD. An elevated risk of stomach, colorectal, and biliary malignancies is linked to the risk of hepatic steatosis. The likelihood of hepatic steatosis raises the risk of gastrointestinal tract malignancies among nondrinkers or light drinkers.

Reference:

Im, S.-G., Shin, C. M., Han, K., Jung, J. H., Choi, J., Jo, H., Lee, H.-K., Jin, E. H., Kang, S. J., Lim, J. H., Choi, Y. J., & Lee, D. H. (2025). Metabolic and alcohol-related steatotic liver disease and gastrointestinal cancer risk in diabetes. Scientific Reports, 15(1), 37224. https://doi.org/10.1038/s41598-025-21005-6