1. In this case-control study, younger age of onset of non-alcoholic fatty liver disease (NAFLD) was associated with greater cancer risk, with greatest risk for digestive and pulmonary cancers.
Evidence rating level: 3 (Average)
The prevalence of non-alcoholic fatty liver disease (NAFLD) is projected to reach 33.5% of the global population by 2030, as the age of onset becomes increasingly younger. Previous research suggests that NAFLD is associated with a greater risk of liver cancer, GI cancers, and all cancer types. Researchers hypothesized that earlier age of onset of NAFLD would be associated with greater cancer risk. This cohort study was conducted between 2006 and 2021 and included participants from the Kailuan Cohort study. For every identified case of NAFLD, an age and sex-matched control was randomly selected to create the control cohort. There were 31,848 individuals included in both the NAFLD and the control groups. After a median follow-up of 10.16 (95% CI, 7.89-11.67) years, 2415 patients were diagnosed with cancer. Younger age of NAFLD onset was associated with greater cancer risk (ages 45-54 years: average hazard ratio (AHR) 1.50; 95% CI, 1.15-1.97; ages 55-64 years: AHR, 1.13; 95% CI, 0.97-1.33; ages >65 years: AHR, 0.75; 95% CI, 0.45-1.27; p for interaction < .001). Among those who developed NAFLD prior to age 45, the risk of cancer was greatest for digestive AHR 2.00 (95% CI, 1.08-3.47) and lung AHR 2.14 (95% CI, 1.05-4.36) cancers. One limitation of the study is that only 17.2% of participants were female, leading to potential sex bias in the results. Overall, this study demonstrates that developing NAFLD at a younger age increases cancer risk, which may become a more significant global health concern as the prevalence of NAFLD continues to increase worldwide.
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