S1100 Could Non-Alcoholic Fatty Liver Disease Be an Additional Predisposing Factor for Colorectal Cancer? A Large Population-Based Study in the US

Abstract

Introduction: Colorectal cancer (CRC) is the 3rd leading cause of cancer-related deaths in the US. Risk factors include advanced age, smoking, alcohol, inflammatory bowel disease, obesity, and inheritance. Metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) have recently been suggested to be associated with an increased risk of CRC, by inducing a proinflammatory status and insulin resistance which in turn elevate insulin levels and insulin-like growth factors, inhibiting apoptosis and promoting proliferation of colonic neoplasia. This association between NAFLD and CRC has not been widely investigated and current evidence remains conflicting. We performed a database analysis aiming to better evaluate any possible predisposition. Methods: We reviewed charts from a commercial database (Explorys Inc, Cleveland, OH) which is an aggregate of electronic health records from 26 major healthcare systems throughout the US. We included all active patients between ages 30 and 75. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Nonalcoholic fatty liver disease” was identified. The outcome was CRC between 2016 and 2021. We excluded patients with inflammatory bowel disease and family history of CRC. The prevalence of CRC in NAFLD patients was calculated using a univariate analysis. The predictors were age, gender, race, diabetes, obesity, and alcohol abuse. Results: Of 43,793,790 individuals in the database (2016-2021), 458,250 had a diagnosis of NAFLD (study group). The prevalence of CRC in this group was 20%, which is 7 times higher than the prevalence detected in the control group who did not have NALFD (3%) (Table 1). In a univariate analysis, patients with NAFLD were statistically more likely to develop CRC compared to controls [OR: 8.7; 95% CI 8.86-8.81, P-value < 0.001] (Table 2). In addition, race other than White and African American was most predictive to develop CRC amongst all risk factors in the analysis [OR: 34; 95% CI 32.99-34.99, P-value < 0.001]. Conclusion: Our study shows an increased risk of developing CRC in patients with NAFLD compared to the general population. Despite its large sample size, our study has some caveats such as its retrospective design and the inability to evaluate diagnosis criteria and severity of NAFLD. Given the rising prevalence of NAFLD, further prospective studies are well needed to shed more light on this potential predisposing factor for CRC which could potentially alter screening strategies in affected patients.Table 1.: Mortality, LOS and Total Hospital Charge.