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The Risk of Incident Extrahepatic Cancers is higher in Nonalcoholic Fatty Liver Disease than Obesity - a Longitudinal Cohort Study.

A. Allen,S. B. Hicks,K. Mara,J. Larson,T. Therneau

Published 2019 in Journal of Hepatology

ABSTRACT

BACKGROUND &Aims: Cancer is a major cause of death in nonalcoholic fatty liver disease (NAFLD). Obesity is a risk factor for cancers; however, the role of NAFLD in this association is unknown. We investigated the effect of NAFLD versus obesity on incident cancers. METHODS We identified all incident cases of NAFLD in a US population between 1997-2016. Subjects with NAFLD were matched by age and sex to referent individuals from the same population (1:3) on the index diagnosis date. We ascertained the incidence of cancer after index date until death, loss to follow-up or study end. NAFLD and cancer were defined using a code-based algorithm with high validity tested by medical record review. The association between NAFLD versus obesity and cancer risk was examined using Poisson regression. RESULTS A total of 4,722 NAFLD subjects (age 54, 46% male) and 14,441 age- and sex-matched referent individuals were followed for a median of 8 (range 1-21) years, during which 2,224 incident cancers occurred. NAFLD was associated with 90% higher risk of malignancy: IRR= 1.9 (95%CI 1.3, 2.7). The highest risk increase was noted in liver cancer, IRR=2.8 (95%CI 1.6, 5.1), followed by uterine IRR=2.3 (95%CI 1.4, 4.1), stomach IRR=2.3 (95%CI 1.3, 4.1), pancreas IRR=2.0 (95%CI 1.2, 3.3) and colon cancer IRR=1.8 (95%CI 1.1, 2.8). In reference to non-obese controls, NAFLD was associated with higher risk of incident cancers (IRR=2.0, 95% CI 1.5, 2.9), while obesity alone was not (IRR=1.0, 95%CI 0.8, 1.4). CONCLUSIONS NAFLD was associated with increased cancer risk, particularity of gastrointestinal types. In the absence of NAFLD, the association between obesity and cancer risk is small, suggesting that NAFLD may be a mediator of obesity-cancer association. LAY SUMMARY We studied the incidence of malignancies in a community cohort of adults with nonalcoholic fatty liver disease (NAFLD) in reference to age- and sex-matched adults without NAFLD. After 21 years of longitudinal follow-up, NAFLD was associated with nearly a 2-fold risk of developing cancers, predominantly of liver, gastrointestinal tract and uterus. The association with increased cancer risk was stronger in NAFLD than obesity.

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