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Using Cox proportional hazard models, we calculated multivariable adjusted hazard ratios (aHRs) and confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We documented 359 incidents of pancreatic diseases in MASLD patients and 880 events in matched reference individuals, resulting in an incidence rate difference of 1.54 (95% CI, 1.25\u20131.84). The relative risk of pancreatic disease was highest in the first two years after MASLD diagnosis (aHR, 2.19 [95% CI, 1.92\u20132.50), but remained statistically significant increased even up to ten years [aHR, 1.60 (95% CI, 1.38\u20131.85)]. The most common pancreatic disease in individuals with MASLD was acute non\u2010biliary pancreatitis (1.44 vs. 0.44 events\/1000 PY), followed by chronic pancreatitis (0.54 vs. 0.12\/1000 PY) and pancreatic cancer (0.88 vs. 0.47\/1000 PY). We documented 130 versus 344 pancreas\u2010related deaths among individuals with MASLD and their matched comparators, yielding an absolute risk difference of 0.51\/1000 PY and an aHR of 2.41 (95%CI\u00a0=\u00a01.95\u22122.97). The findings were consistent in sibling\u2010controlled analyses with an aHR of 2.21 (95%CI\u00a0=\u00a01.69\u20132.90).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>MASLD was associated with significantly higher rates of acute and chronic pancreatitis of predominantly non\u2010biliary origin, as well as an increased risk of pancreatic cancer and pancreas\u2010related mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ueg2.12761","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:23:39Z","timestamp":1737980619000},"page":"247-256","source":"Crossref","is-referenced-by-count":11,"title":["Metabolic Dysfunction\u2010Associated Steatotic Liver Disease and Pancreatic Disease\u2014A Population\u2010Based Nationwide Cohort and Sibling\u2010Controlled Study"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6496-295X","authenticated-orcid":false,"given":"Miroslav","family":"Vujasinovic","sequence":"first","affiliation":[{"name":"Department of Upper Abdominal Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahim","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Gastroenterology and Hepatology University Digestive Health Care Center Basel\u2014Clarunis  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjorn","family":"Roelstraete","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4808-1762","authenticated-orcid":false,"given":"David","family":"Bergman","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangwei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Sadr\u2010Azodi","sequence":"additional","affiliation":[{"name":"Department of Clinical Science Intervention and Technology Karolinska Institutet  Stockholm Sweden"},{"name":"Unit of Upper Gastrointestinal Surgery Saint G\u00f6ran's Hospital  Stockholm Sweden"},{"name":"Centre for Clinical Research S\u00f6rmland Uppsala University  Eskilstuna 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