Fatty liver linked to colorectal cancer in men, breast cancer in women

Researchers observed that nonalcoholic fatty liver disease was associated with hepatocellular carcinoma in general and with colorectal cancer in men and breast cancer in women, according to recently published data.

“These findings suggest that patients with NAFLD require multidisciplinary evaluation with attention given to the development of malignancy,” the researchers wrote.

To identify the incidence rates of various cancers in patients with NAFLD and the association between NAFLD and cancer development, the researchers identified patients who underwent a comprehensive health checkup between Sept. 1, 2004, and Dec. 31, 2005.

Patients were excluded if they had a history of excessive alcohol consumption, hepatitis B or hepatitis C and any history of cancer or diagnosis at baseline.

Of the 25,947 patients included, 8,721 had NAFLD. NAFLD was diagnosed by abdominal ultrasound and severity of fibrosis was assessed by NAFLD fibrosis score (NFS) and fibrosis-4 score (FIB-4). Median follow-up was 7.5 years (range, 3.2-9.3 years).

During follow-up, 440 patients with NAFLD (782.9 per 100,000 person-years; 95% CI, 711.5-859.7) and 643 patients without NAFLD (592.8 per 100,000 person-years; 95% CI, 547.8-640.4) developed malignancies, which was significantly higher in the NAFLD group (IRR = 1.32; 95% CI, 1.17-1.49).

Compared with patients without NAFLD, those with NAFLD had higher rates of HCC (IRR = 25.09; 95% CI 3.28-191.83) and colorectal cancer (IRR = 2.04; 95% CI, 1.3-3.19). Additionally, men with NAFLD had higher rates of HCC (IRR = 14.8; 95% CI, 1.93-113.85) and colorectal cancer (IRR = 2.21; 95% CI, 1.26-3.87) and women with NAFLD had higher rates of breast cancer (IRR = 1.77; 95% CI, 1.15-2.74).

The researchers found that NAFLD correlated with the development of all cancers (HR = 1.32; 95% CI, 1.17-1.49) and, after adjusting for age and sex, was significantly associated with HCC (HR = 15.86; 95% CI, 2.07-121.33), colorectal cancer in men (HR = 2.13; 95% CI, 1.22-3.74) and breast cancer in women (HR = 1.9; 95% CI, 1.2-3.01).

NAFLD remained significantly associated with HCC (HR = 16.73; 95% CI, 2.09-133.85), colorectal cancer in men (HR = 2.01; 95% CI, 1.1-3.68) and breast cancer in women (HR = 1.92; 95% CI, 1.15-3.2) after adjusting for demographic and metabolic factors.

Patients with NFS of 1.455 or higher (HR = 1.87; 95% CI, 1.54-2.28) or a FIB-4 score of 1.45 of higher (HR = 1.74; 95% CI, 1.42-2.13) were also more likely to develop any cancer.

The researchers noted that the smaller number of women in the study may have impacted the rate and association of colorectal cancer with NAFLD. They also noted that, regarding the high rates and association of breast cancer in women with NAFLD, the impacts of BMI and hormonal status were not clearly investigated. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.