Association Between Nonalcoholic Fatty Liver Disease and Risk of Early-onset Colorectal Cancer

초록

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of colorectal cancer (CRC) but has rarely been investigated in adults aged <50 years. We assessed the relationship between NAFLD and early-onset CRC according to anatomical site. METHODS: This population-based cohort study included adults aged 20 to 49 years who underwent health checkups in 2009 under the Korean National Health Insurance Service with follow-up until 2019. NAFLD was defined as a fatty liver index (FLI) of >= 60. Early-onset CRC diagnosed during follow-up was confirmed using claims data. RESULTS: A total of 4,657,825 subjects were categorized into NAFLD (FLI >= 60), borderline NAFLD (30 <= FLI <60), and no NAFLD (FLI <30) groups, with 2733 cases of early-onset CRC identified during a median follow-up of 9.3 years. Early-onset CRC risk was significantly higher in the NAFLD (adjusted hazard ratio, 1.24; 95% confidence interval, 1.17-1.31) and borderline NAFLD (adjusted hazard ratio, 1.12; 95% confidence interval, 1.07-1.17) groups compared with the no-NAFLD group. A dose-response association between FLI and early-onset CRC risk was observed only in the left colon and rectum. Subgroup analysis revealed stronger associations in males, individuals aged 20 to 29 years, and non-diabetic participants (P for interaction < .05). CONCLUSIONS: NAFLD is associated with an increased risk of early-onset CRC, particularly in the left colon and rectum. These findings highlight the need for multifaceted preventive strategies, including lifestyle interventions and expanded screening for younger populations with NAFLD.

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