Colorectal neoplasms in relation to non-alcoholic fatty liver disease in Korean women: A retrospective cohort study

Background and Aim: Metabolic syndrome has been associated with an increased risk for colorectal cancer. Non-alcoholic fatty liver disease (NAFLD) is regarded as a hepatic manifestation of metabolic syndrome. We investigated whether NAFLD is associated with colorectal neoplasms in Korean women. Methods: This retrospective cohort study included data from 5517 women, aged 35-80 years, who underwent life insurance company health examinations between July 2002 and June 2006. Fatty liver disease was assessed by abdominal ultrasound, with NAFLD defined as fatty liver disease in the absence of alcohol use of > 40 g/week or other secondary causes. The incidence of colorectal neoplasms through December 2008 was obtained through medical certificate codes for insurance claims. The association between NAFLD and the risk of colorectal neoplasms was estimated using standard Cox proportional hazards models. Results: Of the study population, 15.1% were diagnosed with NAFLD. During follow-up, 65 women were verified as having adenornatous polyps and 15 as having colorectal cancer. Adjusted relative risks (95% confidence interval [CH) for adenom.atous polyps by age, low high-density lipoprotein-cholesterol, and NAFLD were 1.12 (95% CI 1.09-1.15). 2.56(95% CI 1.53-4.28) and 1.94(95% CI 1.11-3.40). Adjusted relative risks (95% CI) for colorectal cancer by age and NAFLD were 1.23 (95% CI 1.17-1.29) and 3.08(95% CI 1.02-9.34). Conclusions: Our findings demonstrate a significant relationship between NAFLD and colorectal neoplasms. Among the various manifestations of metabolic syndrome, NAFLD may predict the development of colorectal neoplasms in Korean women.