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