Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China.
JAMA Netw Open. 2023 Sep 5;6(9):e2335511. doi: 10.1001/jamanetworkopen.2023.35511.
The onset age of nonalcoholic fatty liver disease (NAFLD) is decreasing, and whether earlier ages of NAFLD onset are associated with increased cancer risk is currently unclear.
To explore the association between NAFLD new-onset age and cancer risk.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among 179 328 participants included in the Kailuan Cohort Study between 2006 and 2021. In total, 46 100 incident NAFLD cases were identified. For each case, a participant matched by age (older or younger by 1 year) and sex was randomly selected to create a new matched study cohort. Data were analyzed from December 2022 through April 2023.
Onset of NAFLD.
The association between the onset age of NAFLD and the risk of different cancer types was evaluated using weighted Cox regression models. Population-attributable fractions (PAFs) were used to quantify the association of NAFLD with cancer risk at different ages.
Among 63 696 participants (mean [SD] age, 51.37 [12.43] years; 10 932 females [17.2%] and 52 764 males [82.8%]), 31 848 individuals had NAFLD and 31 848 individuals were in the control group. During a median (IQR) follow-up of 10.16 (7.89-11.67) years, 2415 patients were diagnosed with cancer. Compared with the matched group, patients aged less than 45 years at NAFLD onset exhibited a higher risk of cancer (average hazard ratio [AHR], 1.52; 95% CI, 1.09-2.12), and as the onset age of NAFLD increased, the cancer risk decreased (ages 45-54 years: AHR, 1.50; 95% CI, 1.15-1.97; ages 55-64 years: AHR, 1.13; 95% CI, 0.97-1.33; ages >65 years: AHR, 0.75; 95% CI, 0.45-1.27; P for interaction < .001). Among patients aged less than 45 years at NAFLD onset, cancers were mainly digestive system and lung cancers, with AHR values of 2.00 (95% CI, 1.08-3.47) and 2.14 (95% CI, 1.05-4.36), respectively. PAFs also showed that in patients aged less than 45 years at NAFLD onset, 17.83% (95% CI, 4.92%-29.86%) of cancer risk was attributable to NAFLD..
This study found that NAFLD was associated with increased cancer risk and there was an interaction with onset age, such that the younger the onset age of NAFLD, the greater the cancer risk.
非酒精性脂肪性肝病（NAFLD）的发病年龄正在降低，目前尚不清楚NAFLD 发病年龄较早是否与癌症风险增加有关。
探讨 NAFLD 新发年龄与癌症风险之间的关系。
设计、设置和参与者：本队列研究纳入了 2006 年至 2021 年间参加开滦队列研究的 179328 名参与者。共确定了 46100 例新发 NAFLD 病例。对于每个病例，通过年龄（年长或年轻 1 岁）和性别随机选择一名匹配的参与者，以创建一个新的匹配研究队列。数据分析于 2022 年 12 月至 2023 年 4 月进行。
NAFLD 的发病。
使用加权 Cox 回归模型评估 NAFLD 发病年龄与不同癌症类型风险之间的关系。使用人群归因分数（PAF）来量化不同年龄 NAFLD 与癌症风险的关联。
在 63696 名参与者（平均[SD]年龄，51.37[12.43]岁；10932 名女性[17.2%]和 52764 名男性[82.8%]）中，31848 人患有 NAFLD，31848 人在对照组。在中位（IQR）随访 10.16（7.89-11.67）年后，2415 名患者被诊断患有癌症。与匹配组相比，NAFLD 发病年龄小于 45 岁的患者癌症风险更高（平均危害比[AHR]，1.52；95%CI，1.09-2.12），随着 NAFLD 发病年龄的增加，癌症风险降低（年龄 45-54 岁：AHR，1.50；95%CI，1.15-1.97；年龄 55-64 岁：AHR，1.13；95%CI，0.97-1.33；年龄>65 岁：AHR，0.75；95%CI，0.45-1.27；P 交互 < .001）。在 NAFLD 发病年龄小于 45 岁的患者中，癌症主要为消化系统和肺癌，AHR 值分别为 2.00（95%CI，1.08-3.47）和 2.14（95%CI，1.05-4.36）。PAF 也表明，在 NAFLD 发病年龄小于 45 岁的患者中，17.83%（95%CI，4.92%-29.86%）的癌症风险归因于 NAFLD。
本研究发现，NAFLD 与癌症风险增加有关，且与发病年龄存在交互作用，即 NAFLD 发病年龄越小，癌症风险越大。
