Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Internal Medicine, Mayo Clinic, Rochester MN, USA.
J Hepatol. 2019 Dec;71(6):1229-1236. doi: 10.1016/j.jhep.2019.08.018. Epub 2019 Aug 27.
BACKGROUND & AIMS: Cancer is a major cause of death in patients with non-alcoholic fatty liver disease (NAFLD). Obesity is a risk factor for cancers; however, the role of NAFLD in this association is unknown. We investigated the effect of NAFLD versus obesity on incident cancers.
We identified all incident cases of NAFLD in a US population between 1997-2016. Individuals with NAFLD were matched by age and sex to referent individuals from the same population (1:3) on the index diagnosis date. We ascertained the incidence of cancer after index date until death, loss to follow-up or study end. NAFLD and cancer were defined using a code-based algorithm with high validity and tested by medical record review. The association between NAFLD or obesity and cancer risk was examined using Poisson regression.
A total of 4,722 individuals with NAFLD (median age 54, 46% male) and 14,441 age- and sex-matched referent individuals were followed for a median of 8 (range 1-21) years, during which 2,224 incident cancers occurred. NAFLD was associated with 90% higher risk of malignancy: incidence rate ratio (IRR) = 1.9 (95% CI 1.3-2.7). The highest risk increase was noted in liver cancer, IRR = 2.8 (95% CI 1.6-5.1), followed by uterine IRR = 2.3 (95% CI 1.4-4.1), stomach IRR = 2.3 (95% CI 1.3-4.1), pancreas IRR = 2.0 (95% CI 1.2-3.3) and colon cancer IRR = 1.8 (95% CI 1.1-2.8). In reference to non-obese controls, NAFLD was associated with a higher risk of incident cancers (IRR = 2.0, 95% CI 1.5-2.9), while obesity alone was not (IRR = 1.0, 95% CI 0.8-1.4).
NAFLD was associated with increased cancer risk, particularity of gastrointestinal types. In the absence of NAFLD, the association between obesity and cancer risk is small, suggesting that NAFLD may be a mediator of the obesity-cancer association.
We studied the incidence of malignancies in a community cohort of adults with non-alcoholic fatty liver disease (NAFLD) in reference to age- and sex-matched adults without NAFLD. After 21 years of longitudinal follow-up, NAFLD was associated with a nearly 2-fold increase in the risk of developing cancers, predominantly of the liver, gastrointestinal tract and uterus. The association with increased cancer risk was stronger in NAFLD than obesity.
癌症是非酒精性脂肪性肝病（NAFLD）患者死亡的主要原因。肥胖是癌症的危险因素；然而，NAFLD 在这种关联中的作用尚不清楚。我们研究了 NAFLD 与肥胖对癌症发病率的影响。
我们在 1997-2016 年间在美国人群中确定了所有的 NAFLD 新发病例。NAFLD 患者按照年龄和性别与同一人群中的参考个体（1:3）在指数诊断日期进行匹配。我们在指数日期后确定癌症的发病率，直至死亡、失访或研究结束。NAFLD 和癌症是使用基于代码的算法定义的，具有较高的有效性，并通过病历审查进行了测试。使用泊松回归检验 NAFLD 或肥胖与癌症风险之间的关联。
共有 4722 名 NAFLD 患者（中位年龄 54 岁，46%为男性）和 14441 名年龄和性别匹配的参考个体接受了中位 8 年（范围 1-21 年）的随访，在此期间发生了 2224 例癌症新发病例。NAFLD 与恶性肿瘤风险增加 90%相关：发病率比（IRR）=1.9（95%CI 1.3-2.7）。肝癌风险增加最高，IRR=2.8（95%CI 1.6-5.1），其次是子宫癌，IRR=2.3（95%CI 1.4-4.1）、胃癌，IRR=2.3（95%CI 1.3-4.1）、胰腺癌，IRR=2.0（95%CI 1.2-3.3）和结肠癌，IRR=1.8（95%CI 1.1-2.8）。与非肥胖对照组相比，NAFLD 与癌症发病率增加相关（IRR=2.0，95%CI 1.5-2.9），而单纯肥胖则不相关（IRR=1.0，95%CI 0.8-1.4）。
NAFLD 与癌症风险增加有关，特别是胃肠道类型。在没有 NAFLD 的情况下，肥胖与癌症风险之间的关联很小，这表明 NAFLD 可能是肥胖与癌症关联的中介。
我们研究了非酒精性脂肪性肝病（NAFLD）社区队列中成年人的恶性肿瘤发病率，并与无 NAFLD 的年龄和性别匹配的成年人进行了比较。在 21 年的纵向随访后，NAFLD 使癌症风险增加近 2 倍，主要是肝脏、胃肠道和子宫的癌症。NAFLD 与癌症风险增加的相关性强于肥胖。
