Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
Liver Int. 2024 Jan;44(1):6-14. doi: 10.1111/liv.15763. Epub 2023 Oct 13.
BACKGROUND & AIMS: Obesity and non-alcoholic fatty liver disease (NAFLD) are known risk factors for gastrointestinal (GI) cancers. However, GI carcinogenesis in lean NAFLD patients remains unclear. This systematic review and meta-analysis aims to investigate the association between lean NAFLD and GI cancer risk.
PubMed, Embase and Cochrane Library databases were systematically searched (from inception date to April 2023) for cohort studies assessing GI cancers in lean (body mass index [BMI] < 25 kg/m or < 23 kg/m in Asians) and non-lean (BMI ≥25 kg/m or ≥ 23 kg/m in Asians) NAFLD individuals. Data from eligible studies were extracted, and meta-analysis was carried out using a random effects model to obtain risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses, meta-regressions and sensitivity analyses were also performed. This study was registered in PROSPERO (CRD42023420902).
Eight studies with 56,745 NAFLD individuals (11% were lean) and 704 cases of incident GI cancers were included. Lean NAFLD was associated with higher risk of hepatic (RR 1.77, 95% CI 1.15-2.73), pancreatic (RR 1.97, 95% CI 1.01-3.86) and colorectal cancers (RR 1.53, 95% CI 1.12-2.09), compared to non-lean NAFLD. No significant differences were observed for oesophagus, gastric, biliary and small intestine cancers.
This study shows that lean NAFLD patients have an increased risk of liver, pancreatic and colorectal cancers compared to non-lean NAFLD patients, emphasizing the need to explore tailored cancer prevention strategies for this specific patient group. Further research is required to explore the mechanisms underlying the association between lean NAFLD and specific GI cancers.
肥胖和非酒精性脂肪性肝病（NAFLD）是胃肠道（GI）癌症的已知危险因素。然而，瘦型 NAFLD 患者的 GI 癌变机制仍不清楚。本系统评价和荟萃分析旨在研究瘦型 NAFLD 与 GI 癌症风险之间的关系。
系统检索 PubMed、Embase 和 Cochrane 图书馆数据库（从建库日期至 2023 年 4 月），以评估瘦型（BMI<25kg/m 或亚洲人群 BMI<23kg/m）和非瘦型（BMI≥25kg/m 或亚洲人群 BMI≥23kg/m）NAFLD 个体中 GI 癌症的队列研究。提取合格研究的数据，并使用随机效应模型进行荟萃分析，以获得风险比（RR）及其 95%置信区间（CI）。还进行了亚组分析、meta 回归和敏感性分析。本研究已在 PROSPERO（CRD42023420902）注册。
纳入 8 项研究，共 56745 例 NAFLD 患者（11%为瘦型）和 704 例 GI 癌症病例。与非瘦型 NAFLD 相比，瘦型 NAFLD 与肝脏（RR 1.77，95%CI 1.15-2.73）、胰腺（RR 1.97，95%CI 1.01-3.86）和结直肠（RR 1.53，95%CI 1.12-2.09）癌症的风险增加相关。而食管、胃、胆道和小肠癌症的风险无显著差异。
本研究表明，与非瘦型 NAFLD 患者相比，瘦型 NAFLD 患者的肝脏、胰腺和结直肠癌症风险增加，强调需要为这一特定患者群体探索量身定制的癌症预防策略。需要进一步研究以探索瘦型 NAFLD 与特定 GI 癌症之间关联的机制。
