非酒精性脂肪性肝病的全球患病率及其与癌症的关联：系统评价与荟萃分析
The Global Prevalence of Nonalcoholic Fatty Liver Disease and its Association With Cancers: Systematic Review and Meta-Analysis.
作者信息
Muhamad Nor Asiah, Maamor Nur Hasnah, Leman Fatin Norhasny, Mohamad Zuraifah Asrah, Bakon Sophia Karen, Abdul Mutalip Mohd Hatta, Rosli Izzah Athirah, Aris Tahir, Lai Nai Ming, Abu Hassan Muhammad Radzi
机构信息
Sector for Evidence-based Healthcare, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia.
Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia.
出版信息
Interact J Med Res. 2023 Jul 19;12:e40653. doi: 10.2196/40653.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is one of the common causes of chronic liver disease globally. Obesity, metabolic diseases, and exposure to some environmental agents contribute to NAFLD. NAFLD is commonly considered a precursor for some types of cancers. Since the leading causes of death in people with NAFLD are cardiovascular disease and extrahepatic cancers, it is important to understand the mechanisms of the progression of NAFLD to control its progression and identify its association with extrahepatic cancers. Thus, this review aims to estimate the global prevalence of NAFLD in association with the risk of extrahepatic cancers.
OBJECTIVE
We aimed to determine the prevalence of various cancers in NAFLD patients and the association between NAFLD and cancer.
METHODS
We searched PubMed, ProQuest, Scopus, and Web of Science from database inception to March 2022 to identify eligible studies reporting the prevalence of NAFLD and the risk of incident cancers among adult individuals (aged ≥18 years). Data from selected studies were extracted, and meta-analysis was performed using random effects models to obtain the pooled prevalence with the 95% CI. The quality of the evidence was assessed with the Newcastle-Ottawa Scale.
RESULTS
We identified 11 studies that met our inclusion criteria, involving 222,523 adults and 3 types of cancer: hepatocellular carcinoma (HCC), breast cancer, and other types of extrahepatic cancer. The overall pooled prevalence of NAFLD and cancer was 26% (95% CI 16%-35%), while 25% of people had NAFLD and HCC (95% CI 7%-42%). NAFLD and breast cancer had the highest prevalence out of the 3 forms of cancer at 30% (95% CI 14%-45%), while the pooled prevalence for NAFLD and other cancers was 21% (95% CI 12%-31%).
CONCLUSIONS
The review suggests that people with NAFLD may be at an increased risk of cancer that might not affect not only the liver but also other organs, such as the breast and bile duct. The findings serve as important evidence for policymakers to evaluate and recommend measures to reduce the prevalence of NAFLD through lifestyle and environmental preventive approaches.
TRIAL REGISTRATION
PROSPERO CRD42022321946; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321946.
背景
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病的常见病因之一。肥胖、代谢性疾病以及接触某些环境因素会导致NAFLD。NAFLD通常被认为是某些类型癌症的先兆。由于NAFLD患者的主要死因是心血管疾病和肝外癌症，了解NAFLD的进展机制对于控制其进展以及确定其与肝外癌症的关联至关重要。因此，本综述旨在评估与肝外癌症风险相关的NAFLD全球患病率。
目的
我们旨在确定NAFLD患者中各种癌症的患病率以及NAFLD与癌症之间的关联。
方法
我们检索了从数据库建立到2022年3月的PubMed、ProQuest、Scopus和Web of Science，以识别报告成人（年龄≥18岁）中NAFLD患病率和新发癌症风险的符合条件的研究。提取所选研究的数据，并使用随机效应模型进行荟萃分析，以获得合并患病率及95%置信区间。证据质量采用纽卡斯尔-渥太华量表进行评估。
结果
我们确定了11项符合纳入标准的研究，涉及222,523名成年人以及3种癌症类型：肝细胞癌（HCC）、乳腺癌和其他类型的肝外癌症。NAFLD和癌症的总体合并患病率为26%（95%置信区间16%-35%），而25%的人患有NAFLD和HCC（95%置信区间7%-42%）。在这3种癌症类型中，NAFLD和乳腺癌的患病率最高，为30%（95%置信区间14%-45%），而NAFLD和其他癌症的合并患病率为21%（95%置信区间12%-31%）。
结论
该综述表明，NAFLD患者患癌症的风险可能增加，这可能不仅影响肝脏，还会影响其他器官，如乳腺和胆管。这些发现为政策制定者通过生活方式和环境预防措施评估和推荐降低NAFLD患病率的措施提供了重要证据。
试验注册
PROSPERO CRD42022321946；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321946。
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