Dysregulated growth hormone-insulin-like growth factor-1 axis in adults with metabolic dysfunction-associated steatotic liver disease: a meta-analysis

Aim: A dysregulated growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis may contribute to the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). However, the available evidence remains inconsistent. Data synthesis: We systematically searched PubMed and Scopus from database inception through 31 January 2026 to identify eligible observational studies assessing the association between circulating GH and IGF-1 levels and MASLD (diagnosed by liver biopsy or imaging). The primary outcome was the difference in circulating GH and IGF-1 levels between adults (age >18 years) with and without MASLD. Effect sizes were expressed as weighted mean differences (WMDs) with 95% confidence intervals (95%CI). A total of 18 observational studies were included. Fourteen studies (13,112 participants) measured circulating IGF-1 levels, five studies (7500 participants) measured circulating GH levels, and one study assessed both hormones. Individuals with MASLD had significantly lower circulating GH (random-effects WMD: -0.34 ng/ml; 95%CI, -0.61 to -0.07; I2 = 81.5%) and IGF-1 (random-effects WMD: -24.85 ng/ml; 95%CI, -37.88 to -11.81; I2 = 94.8%) levels than controls. Circulating IGF-1 levels were also lower in individuals with biopsy-confirmed metabolic dysfunction-associated steatohepatitis or advanced liver fibrosis (F2-F4 stages). Sensitivity analyses did not substantially alter these findings. Conclusion: Circulating GH and IGF-1 levels are inversely associated with the presence and severity of MASLD. Further studies are needed to better understand the complex but existing link between a dysregulated (suppressed) GH-IGF-1 axis and MASLD.