An international Delphi panel of 35 experts from six continents rated 17 statements on colorectal cancer (CRC) in metabolic dysfunction-associated steatotic liver disease (MASLD), and reached consensus on all.

The panel agreed that MASLD is associated with increased CRC risk, that greater metabolic burden raises it further, and that more severe liver disease is associated with worse outcomes in patients who develop CRC. It identified weight loss through lifestyle change, bariatric surgery, GLP-1 receptor agonists and early screening as potential risk-reduction strategies, and called for earlier, risk-adapted screening.

MASLD is extremely common in Indian practice, and most patients are seen for their liver, not their colon. This statement asks hepatology and gastroenterology clinics to think about colorectal screening in the same visit. It is expert opinion built on observational data; it does not define a screening age or interval.

Ask every MASLD patient about colorectal screening status
Do not delay screening in MASLD with diabetes or obesity when they reach screening age
Take bowel symptoms and iron deficiency seriously in this group
Treat the metabolic drivers: weight, glucose, lipids

Why it matters

MASLD care focuses on the liver, but the same metabolic risk may be showing up in the colon.

Don't overread it

This is a consensus of expert opinion on observational evidence; it does not set a new screening age or show that earlier screening improves outcomes.