{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Chu-Tian Wu"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Verona, Verona, Italy",
        "Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy"
      ],
      "name": "Giovanni Targher"
    },
    {
      "affiliations": [
        "Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK"
      ],
      "name": "Christopher D Byrne"
    },
    {
      "affiliations": [
        "The Global NASH/MASH Council, Washington, DC, USA",
        "Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA",
        "Center for Outcomes Research in Liver Diseases, Washington, DC, USA"
      ],
      "name": "Zobair M Younossi"
    },
    {
      "affiliations": [
        "Liver Unit, Queen Elizabeth University Hospital, Birmingham, UK",
        "Birmingham NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK"
      ],
      "name": "Matthew J Armstrong"
    },
    {
      "affiliations": [
        "Dr. Mary and Ron Neal Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA",
        "Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA",
        "Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Hung N Luu"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty, University of Indonesia, Jakarta, Indonesia",
        "Digestive Disease and GI Oncology Centre, Medistra Hospital, Jakarta, Indonesia"
      ],
      "name": "Cosmas Rinaldi A Lesmana"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA",
        "Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"
      ],
      "name": "Vinod K Rustgi"
    },
    {
      "affiliations": [
        "Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia",
        "Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia"
      ],
      "name": "James A Thomas"
    },
    {
      "affiliations": [
        "Department of Surgery, Keio University School of Medicine, Tokyo, Japan"
      ],
      "name": "Koji Okabayashi"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, National University Hospital, Singapore",
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "iHealthtech, National University of Singapore, Singapore"
      ],
      "name": "Jonathan Wei Jie Lee"
    },
    {
      "affiliations": [
        "Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Hashem B El-Serag"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea"
      ],
      "name": "Won Kim"
    },
    {
      "affiliations": [
        "Department of Oncology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China"
      ],
      "name": "Hai-Jun Zhang"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Ospedale Civile di Baggiovara (-2023), Azienda Ospedaliero-Universitaria di Modena, Modena, Italy"
      ],
      "name": "Amedeo Lonardo"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"
      ],
      "name": "Matheus Souza"
    },
    {
      "affiliations": [
        "Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia"
      ],
      "name": "Elena S George"
    },
    {
      "affiliations": [
        "Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China"
      ],
      "name": "Wah Yang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Türkiye"
      ],
      "name": "Yusuf Yilmaz"
    },
    {
      "affiliations": [
        "1st Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece"
      ],
      "name": "George Papatheodoridis"
    },
    {
      "affiliations": [
        "Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina",
        "Department of Clinical and Molecular Hepatology, Translational Research in Health Center (CENITRES), Maimónides University, Buenos Aires, Argentina"
      ],
      "name": "Silvia Sookoian"
    },
    {
      "affiliations": [
        "Digestive Diseases Unit and CIBERehd, Virgen Del Rocío University Hospital, Sevilla, Spain",
        "Institute of Biomedicine of Seville (HUVR/CSIC/US), University of Seville, Sevilla, Spain"
      ],
      "name": "Manuel Romero-Gómez"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada"
      ],
      "name": "Giada Sebastiani"
    },
    {
      "affiliations": [
        "Department of Medicine II, University Medical Center Homburg, Homburg and Saarland University, Saarbrücken, Germany"
      ],
      "name": "Jörn M Schattenberg"
    },
    {
      "affiliations": [
        "Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt",
        "Applied Science Research Center, Applied Science Private University, Amman, Jordan",
        "Steatotic Liver Disease Study Foundation in Middle East and North Africa (SLMENA), Cairo, Egypt"
      ],
      "name": "Mohamed El-Kassas"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia"
      ],
      "name": "Wah-Kheong Chan"
    },
    {
      "affiliations": [
        "Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda"
      ],
      "name": "Ponsiano Ocama"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania"
      ],
      "name": "Monica Lupșor-Platon"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka"
      ],
      "name": "Nilanka Perera"
    },
    {
      "affiliations": [
        "Liver Disease Research Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia"
      ],
      "name": "Khalid Alswat"
    },
    {
      "affiliations": [
        "Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico",
        "Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico"
      ],
      "name": "Nahum Méndez-Sánchez"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China",
        "State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Vincent Wai-Sun Wong"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, the First Affiliated Hospital (Southwest Hospital) of Third Military Medical University (Army Medical University), Chongqing, China",
        "Institute of Digestive Diseases of PLA, the First Affiliated Hospital (Southwest Hospital) of Third Military Medical University (Army Medical University), Chongqing, China",
        "Cholestatic Liver Diseases Center and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Medical Research Center, the First Affiliated Hospital (Southwest Hospital) of Third Military Medical University (Army Medical University), Chongqing, China"
      ],
      "name": "Jin Chai"
    },
    {
      "affiliations": [
        "Department of Internal Medicine I, Gastroenterology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria"
      ],
      "name": "Herbert Tilg"
    },
    {
      "affiliations": [
        "Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"
      ],
      "name": "Joseph Jao-Yiu Sung"
    },
    {
      "affiliations": [
        "MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China",
        "Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China"
      ],
      "name": "Ming-Hua Zheng"
    }
  ],
  "title": "Colorectal cancer in metabolic dysfunction-associated steatotic liver disease: an international Delphi consensus statement",
  "uid": "2d2f5c2a-a894-5ecf-b641-c18b3746a904"
}