Age of NAFLD onset associated with cancer risk

Developing new-onset non-alcoholic fatty liver disease (NAFLD) at a young age is associated with an increased risk of cancer, a matched cohort study shows.

The results showed that patients younger than 45 years at the onset of NAFLD had a higher risk of developing cancer, and that the risk decreased with increasing age at NAFLD onset.¹

“Importantly, the population with NAFLD is becoming younger,” the researchers wrote.¹ “Of those who died related to chronic liver disease, one in three had NAFLD when they were under 30 years old. These results indicate that attention must be paid to the relationship between new-onset NAFLD and the risk of other diseases such as cancer at different ages. relation.”

It is estimated that approximately 100 million people in the United States have NAFLD. People who are overweight, obese, or have diabetes, high cholesterol, or high triglycerides are at risk for NAFLD.² Being considered overweight or obese can also lead to a greater risk of certain cancers.³

To assess the association between age at incident NAFLD and cancer risk, Dr. Hanping Shi, a senior researcher in the Department of Surgery at Millennium Monument Hospital in Beijing, China, and a team of researchers matched patients with and without incident NAFLD using data from the Kailuan Cohort Study. of participants. The Kailuan Cohort Study is an ongoing prospective cohort study that was launched in June 2006. It collects physical examination data, questionnaire interview data, dietary information and laboratory test results of Kailuan Group employees every two years, and conducts follow-up visits every year. .¹

To be included in the study, patients had to have attended at least 2 physical examinations between 2006 and 2017, with the first examination showing no NAFLD and the presence of NAFLD on subsequent examinations. Patients with a previous diagnosis or history of NAFLD, cancer, alcoholism, hepatitis B virus infection, or other liver disease were excluded.¹

Investigators found 46,100 cases of NAFLD. After excluding patients with missing covariate data at diagnosis and matching remaining patients 1:1 with participants without NAFLD based on age and sex, 31,848 pairs of participants were included in the study. Among the entire cohort of 63,696 participants, the mean age was 51.37 (standard deviation (SD), 12.43) years, and 82.8% (n = 52,764) were male.¹

Weighted Cox regression models were used to evaluate the association between age at onset of NAFLD and cancer risk. Researchers used population-attributable fractions to quantify the association of NAFLD with cancer risk across age groups.¹

During a median follow-up of 10.16 years (interquartile range (IQR), 7.89-11.67), 2415 patients were diagnosed with cancer. Of these participants, 1134 were in the matched non-NAFLD group and 1281 were in the NAFLD case group.¹

Compared with controls, patients aged <45 years at onset of NAFLD showed a higher cancer risk (average hazard ratio (AHR), 1.52; 95% confidence interval (CI), 1.09-2.12), and as NAFLD progressed Cancer risk decreases as age at onset increases (ask For interactions < .001):

• 45-54 years old: AHR, 1.50; 95% CI, 1.15-1.97
• 55-64 years: AHR, 1.13; 95% CI, .97-1.33
• Age >65 years: AHR, 0.75; 95% CI, 0.45-1.27

The researchers noted that in the new study, patients aged < 45 years (AHR, 2.00; 95% CI, 1.08-3.47) and patients aged 45 to 54 years (AHR, 1.94; 95% CI, 1.46-2.74) had digestive The risk of systemic cancers is higher. Onset of NAFLD. The younger the age at which NAFLD develops, the higher the risk of liver and lung cancer. Among patients with new-onset NAFLD aged <45 years, the AHRs for liver cancer and lung cancer were 2.66 (95% CI, 1.16-6.11) and 2.14 (95% CI, 1.05-4.36), respectively. Of note, no significant difference in colorectal cancer risk was observed among patients who were younger at onset of NAFLD.¹

The population-attributable fraction of new-onset NAFLD declined with age, a phenomenon observed across all cancer types, the researchers noted. Among patients aged < 45 years at NAFLD onset, 17.83% (95% CI, 4.92%-29.86%) of the cancer risk was attributable to NAFLD.¹

“The rising incidence of non-alcoholic fatty liver disease (NAFLD) among young people highlights the underestimation of the harmful consequences associated with this disease. Our findings suggest that early control and intervention of NAFLD progression may be relevant for reducing NAFLD It is critical to reduce the incidence of cancer and reduce the public health burden,” the researchers concluded.¹

refer to:

1. Liu C, Liu T, Zhang Q, et al. Age at onset of nonalcoholic fatty liver disease and cancer risk. JAMA Network Open. 2023;6(9):e2335511. doi:10.1001/jamanetworkopen.2023.35511
2. American Liver Foundation. Non-alcoholic fatty liver disease (NAFLD). Fatty Liver Disease. Accessed: October 3, 2023. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonanol-fatty-liver-disease-nafld/
3. American Cancer Society. Weight and cancer risk. Diet and physical activity. Accessed: October 3, 2023. https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/body-weight-and-cancer-risk.html