Metabolic dysfunction-associated steatotic liver disease and MetALD increases the risk of liver cancer and gastrointestinal cancer: A nationwide cohort study

Sep 21, 2026

Nationwide cohort evidence evaluates cancer risk in metabolic dysfunction-associated steatotic liver disease (MASLD) and its alcohol-increased subtype, MetALD. Participants in South Korea who underwent health screening in 2011 were followed for 33.9 million person-years. Steatotic liver disease was defined using a fatty liver index threshold and grouped into MASLD, MetALD, other combination aetiology, and no SLD. MASLD and MetALD show higher risks of all cancers versus no SLD, with pronounced increases for liver and gastrointestinal malignancies.

LanguageEnglish

CategoryResearch & Report

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Pages10

Reading Time25 min

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Summary

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Introduction

DOI: 10. 1111/apt.18286 OR I G I NAL ART I C L E Metabolic dysfunction-associated steatotic liver disease and MetALD increases the risk of liver cancer and gastrointestinal cancer: A nationwide cohort study Yewan Park1 | Jooyi Jung2 | Seungbong Han2 | Gi-Ae Kim1 1Department of Internal Medicine, College of Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea 2Department of Biostatistics, Korea University, Seoul, Republic of Korea Correspondence Gi-Ae Kim, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. Email: [antiankle@naver.com](antiankle@naver.com) Funding information Kyung Hee University, Grant/Award Number: KHU-20233264; National Research Foundation of Korea, Grant/Award Number: 2022R1F1A1076449 Summary Background: The new nomenclature of metabolic dysfunction-associated steatotic liver disease (MASLD) substituting nonalcoholic fatty liver disease was proposed along with a new category of MASLD with increased alcohol intake (MetALD) . Aims: We aimed to explore the cancer risk by MASLD and MetALD. Methods: This nationwide cohort study included 3,596,709 participants who underwent a health check-up in 2011 in South Korea. Steatotic liver disease (SLD) was defined as a fatty liver index ≥30 . Participants were categorized into four exclusive groups: MASLD, MetALD, other combination aetiology and no SLD. The subdistribution hazard ratio (SHR) was calculated using the Fine–Gray model after adjusting other variables. Results: During the 33.9 million person-years of follow-up, 285,845 participants (7.9%) developed cancers. Compared with no SLD, MASLD, MetALD and other combination aetiology had an increased risk of all cancer. Liver cancer risk escalated from no SLD to MASLD (SHR, 1. 16; 95% CI, 1.12–1. 21), MetALD (SHR, 2.06; 95% CI, 1.92–2. 20) and other combination aetiology (SHR, 8. 16; 95% CI, 7.69–8. 67) . Gastrointestinal cancers including oesophagus, stomach, colorectal, biliary and pancreas cancers increased in MASLD (SHR, 1. 13; 95% CI, 1.11–1. 15), MetALD (SHR, 1. 17; 95% CI, 1.14–1. 21) and other combination aetiology (SHR, 1.09; 95% CI, 1.05– 1. 13) . A modest increase in lung cancer and hormone-sensitive cancer was observed with MASLD. Conclusions: This study showed that MASLD and MetALD are associated with an increased risk of cancer, particularly liver and gastrointestinal cancers. The findings build new evidence for the clinical outcomes of MetALD while highlighting the importance of managing alcohol intake properly in MASLD and MetALD. | Yewan Park and Jooyi Jung contributed equally to this study and are co-first authors.
The Handling Editor for this article was Dr Vincent Wong, and it was accepted for publication after full peer-review. | | --- | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2024 The Author(s) . Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. | Aliment Pharmacol Ther. 2024;60:1599–[1608.](1608. wileyonlinelibrary.com/journal/apt | 1599)[ wileyonlinelibrary.com/journal/apt](1608. wileyonlinelibrary.com/journal/apt | 1599)[ |](1608. wileyonlinelibrary.com/journal/apt | 1599)[ 1599](1608. wileyonlinelibrary.com/journal/apt | 1599) 1 | INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is an overarching term that includes non-alcoholic fatty liver, non-alcoholic steatohepatitis (NASH) and cirrhosis influencing an estimated 30% of the global population.1–3 Cancer is one of the most common causes of death in NAFLD.4–6 Recent studies have shown that NAFLD has an increased risk of incident hepatocellular carcinoma (HCC) as well as extrahepatic cancers.7–10 Over th

FAQs

How did the study define steatotic liver disease and categorize participants?

Steatotic liver disease was defined using a fatty liver index threshold, and participants were placed into four exclusive groups: MASLD, MetALD, other combination aetiology, and no SLD.

What were the main findings for cancer risk in MASLD and MetALD?

Compared with no SLD, MASLD and MetALD were associated with increased risk of all cancers, with particularly higher risks for liver and gastrointestinal cancers.

Which cancers showed notable increases, according to the results?

Liver cancer risk increased progressively across no SLD to MASLD, MetALD, and other combination aetiology. Gastrointestinal cancers—including oesophagus, stomach, colorectal, biliary, and pancreas—also increased in MASLD and MetALD.

Sep 21, 2026

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