Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as the leading cause of chronic liver disease and may exert systemic oncogenic effects. Evidence linking MASLD to colorectal neoplasia in European populations is limited. We aimed to assess whether MASLD is independently associated with a higher prevalence and distinct histologic profile of colorectal premalignant lesions.

We performed a retrospective, matched case–control study including 150 consecutive adults who underwent complete colonoscopy between January and December 2024. Seventy-five patients with ultrasonographically confirmed MASLD were matched 1:1 to controls by age, sex, residence, and presence of obesity or diabetes. Demographic, metabolic, endoscopic, and histopathologic data were collected. Logistic regression adjusted for metabolic covariates was used to determine the independent association between MASLD and colorectal polyp prevalence.

Colorectal polyps were identified in 39 of 75 MASLD patients (52.0%) versus 20 of 75 controls (26.7%) (χ² = 6.77, p = 0.009). MASLD was independently associated with an increased likelihood of colorectal polyps (adjusted OR 3.04, 95% CI 1.49–6.22, p = 0.002). Adenomatous histology predominated in MASLD (80% tubular/tubulovillous/villous, including 13% with high-grade dysplasia), whereas hyperplastic lesions were more common in controls. No significant difference was found in polyp size or location.

MASLD was independently associated with a threefold higher prevalence of colorectal adenomas. These results identify MASLD as a metabolic risk enhancer for colorectal carcinogenesis and support early colonoscopic screening in metabolically vulnerable populations.

(Note: The full manuscript based on this abstract has been submitted to Diseases of the Colon & Rectum and is currently under editorial review. The data have not been published or presented elsewhere.)