BACKGROUND & AIMS Little is known about the association between non-alcoholic fatty liver disease (NAFLD) and cancer development. This study investigated the cancer incidence rates in NAFLD and analysed the association between NAFLD and cancer development. METHODS This historical cohort study included subjects who were followed up for >1 year after having a heath checkup at a tertiary hospital in Korea from September 1, 2004 to December 31, 2005. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis in the absence of other known liver disease, including alcoholic or viral hepatitis. Cox proportional hazards regression model was conducted to assess the association between NAFLD and cancer development. RESULTS Of 25,947 subjects, 8,721 (33.6%) had NAFLD. During the total follow-up of 164,671 person-years (median 7.5 years), the cancer incidence rate of the NAFLD group was higher than that of the non-NAFLD group (782.9 vs. 592.8 per 100,000 person-years; hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.17-1.49; p <0.001). When demographic and metabolic factors were adjusted for, NAFLD showed a strong association with three cancers: hepatocellular carcinoma ([HCC]; HR 16.73; 95% CI 2.09-133.85; p = 0.008), colorectal cancer in males (HR 2.01; 95% CI 1.10-3.68; p = 0.02), and breast cancer in females (HR 1.92; 95% CI 1.15-3.20; p = 0.01). A high NAFLD fibrosis score (NFS) and a high fibrosis-4 (FIB-4) score were associated with the development of all cancers and HCC. CONCLUSION NAFLD was associated with the development of HCC, colorectal cancer in males, and breast cancer in females. A high NFS and a high FIB-4 score showed a strong association with the development of all cancers and HCC. LAY SUMMARY Non-alcoholic fatty liver disease (NAFLD) is associated with developing hepatocellular carcinoma (HCC). There have been limited data on the association between NAFLD and extrahepatic cancers. This study demonstrated that patients with NAFLD showed a higher association with the development of HCC, colorectal cancer in males, and breast cancer in females. A high NAFLD fibrosis score and a high fibrosis-4 score showed a strong association with the development of all cancers and HCC.

中文翻译：

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非酒精性脂肪肝与癌症发病率的关系


背景与目的 对于非酒精性脂肪肝 (NAFLD) 与癌症发展之间的关联知之甚少。本研究调查了 NAFLD 的癌症发病率，并分析了 NAFLD 与癌症发展之间的关联。方法这项历史队列研究纳入了2004年9月1日至2005年12月31日在韩国一家三级医院进行健康检查后随访>1年的受试者。NAFLD是在没有肝脏脂肪变性的情况下通过超声检测肝脂肪变性来诊断的。其他已知的肝脏疾病，包括酒精性或病毒性肝炎。采用 Cox 比例风险回归模型来评估 NAFLD 与癌症发展之间的关联。结果 25,947 名受试者中，8,721 名 (33.6%) 患有 NAFLD。在164,671人年（中位7.5年）的总随访期间，NAFLD组的癌症发病率高于非NAFLD组（782.9/100,000人年 vs. 592.8/100,000人年；风险比[HR] ] 1.32；95% 置信区间 [CI] 1.17-1.49；p <0.001）。调整人口和代谢因素后，NAFLD 显示与三种癌症密切相关：肝细胞癌（[HCC]；HR 16.73；95% CI 2.09-133.85；p = 0.008）、男性结直肠癌（HR 2.01；95% CI 1.10-3.68；p = 0.02），以及女性乳腺癌（HR 1.92；95% CI 1.15-3.20；p = 0.01）。高 NAFLD 纤维化评分 (NFS) 和高纤维化 4 (FIB-4) 评分与所有癌症和 HCC 的发展相关。结论 NAFLD 与 HCC、男性结直肠癌和女性乳腺癌的发生有关。高 NFS 和高 FIB-4 评分显示与所有癌症和 HCC 的发展密切相关。 简单总结 非酒精性脂肪肝 (NAFLD) 与肝细胞癌 (HCC) 的发生有关。关于 NAFLD 与肝外癌症之间关联的数据有限。这项研究表明，NAFLD 患者与 HCC、男性结直肠癌和女性乳腺癌的发生有较高的相关性。高 NAFLD 纤维化评分和高纤维化 4 评分显示与所有癌症和 HCC 的发展密切相关。