Harlequin baby with ecthyma gangrenosum.

BACKGROUND

The metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most common causes of chronic and abnormal liver function tests globally. The relationship between metabolic MASLD and gastrointestinal tumors (GI) remains controversial.

METHODOLOGY: We conducted a systematic review based on a protocol registered with PROSPERO (CRD42024590389). PubMed, Cochrane Library, Web of Science, and Embase were systematically searched until November 2025, Quality assessment and data extraction were performed by two investigators, and the hazard ratios and their corresponding 95% confidence intervals were combined using Stata for data analysis.

RESULTS

A total of 29 studies were included, we found that MASLD were related to colorectal polyps (I 2 = 62.7, HR = 1.42, 95% CI [1.22-1.66]), colorectal cancer (I 2 = 82.8%, HR = 1.22, 95% CI [1.16-1.29]), p < 0.001) and esophagus cancer (I 2 =88.4, HR = 1.14, 95% CI [1.05-1.24], p < 0.001), gastric cancer (I 2 = 88, HR = 1.18, 95% CI [1.1-1.26]), cholangiocarcinoma (I 2 = 73.7, HR = 1.26, 95% CI [1.1 7-1. 36], P < 0.001) and gallbladder cancer (I 2 = 56.1, HR = 1.41, 95% CI [1.03-1.92], P < 0.001). Factors like follow-up time, study methods and countries contributed to heterogeneity of studies. Lastly, incidence rates (IR) and prognosis of GI cancer in patients with MASLD were highly correlated.

CONCLUSION

We conclude that there is a significant association and prognosis between MASLD and gastrointestinal tumors. Further studies should focus on prospective studies and mechanistic insights.