Metabolic and alcohol-related steatotic liver disease and gastrointestinal cancer risk in diabetes.

We investigated the relationship between incidence of gastrointestinal tract cancers, metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-related steatotic liver disease in diabetic population. A nationwide cohort of 2,616,828 individuals with diabetes under Korean National Health Insurance Service from 2015 to 2016 was divided into four subgroups: no steatosis (group 1), MASLD alone (group 2), MASLD with heavy alcohol intake (group 3), and alcoholic liver disease (group 4). We used fatty liver index to assess the probability of hepatic steatosis using cutoff scores of 30 and 60. We analyzed incidences of esophageal, stomach, colorectal, biliary, and pancreatic cancers until 2022. Compared with group 1 (reference), group 2 showed increased hazard ratios for stomach, colorectal, and biliary cancers, with a decreased hazard ratio for esophageal cancer (adjusted hazard ratio [95% confidence interval]: 1.10 [1.06-1.13], 1.13 [1.10-1.16], 1.10 [1.05-1.16], 0.88 [0.79-0.97], respectively). Probability of hepatic steatosis was positively correlated with all gastrointestinal tract cancers except esophageal cancer in non-drinkers, but only with stomach, colorectal, and biliary cancers in mild drinkers (ptrend < 0.001). In conclusion, MASLD increases gastrointestinal tract cancer risk, except esophageal cancer, in diabetic population. For non or mild drinkers, probability of hepatic steatosis serves as a predictor of gastrointestinal tract cancer risk.