A Systematic Review and Meta-Analysis of Cannabis Use Frequency and Metabolic Dysfunction-Associated Steatotic Liver Disease: Scapegoat or Healer?

Potential associations have been investigated between metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, and cannabis use. This study aimed to determine the association between cannabis use frequency and MASLD. Up to January 2025, the evidence from PubMed, Scopus, and Web of Science was synthesized in this systematic review and meta-analysis, which was registered in PROSPERO (CRD42025025065) and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of the 711 initial records, 11 observational studies involving 5,968,702 individuals met the inclusion criteria. A pooled analysis revealed that cannabis use was associated with a reduced risk of hepatic steatosis (OR = 0.58; 95% CI: 0.42-0.81; p = 0.002; I² = 97%). The subgroup analysis revealed a protective association for past users (OR = 0.84; 95% CI: 0.77-0.93) and occasional users (OR = 0.35; 95% CI: 0.20-0.64), with no significant association observed for frequent users. The study revealed that cannabis users exhibited a decline in both the fatty liver index (mean difference (MD) = -11.02) and the BMI (MD = -1.89 kg/m²). However, the findings did not show any statistically significant changes in liver fat (%), transaminases (aspartate aminotransferase and alanine aminotransferase), and triglycerides. A risk-of-bias assessment identified notable methodological limitations. Overall, the findings suggest a strong association between cannabis use and MASLD, though causality cannot be established.