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Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis

Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis
Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis
BACKGROUND:
It is currently uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of colorectal tumours. We performed a meta-analysis of relevant observational studies to quantify the magnitude of the association between NAFLD and risk of colorectal adenomas and cancer.
METHODS:
We searched PubMed, Scopus and Web of Science from January 2000 to November 2017 using pre-defined keywords to identify observational studies of asymptomatic adults undergoing screening colonoscopy, in which NAFLD was diagnosed by imaging or histology. Data from selected studies were extracted and meta-analysis was performed using random-effects modelling.
RESULTS:
Eleven observational studies (8 cross-sectional and 3 longitudinal) with aggregate data on 91,124 asymptomatic adults of predominantly Asian descent (32.1% with NAFLD) accounting for a total of 14,911 colorectal adenomas and 1684 cancers were included in the final analysis. NAFLD was associated with an increased risk of prevalent colorectal adenomas (n = 7 studies using liver imaging techniques; random-effects odds ratio [OR] 1.28, 95%CI 1.11-1.48; I2 = 82.9% or n = 1 study using liver biopsy; random-effects OR 1.61, 95%CI 0.90-2.89) and cancer (n = 4 studies using liver imaging techniques; random-effects OR 1.56, 95%CI 1.25-1.94; I2 = 65.6% or n = 1 study using liver biopsy; random-effects OR 3.04, 95%CI 1.29-7.18). NAFLD was also associated with an increased risk of incident colorectal adenomas (n = 3 studies; random-effects hazard ratio [HR] 1.42, 95%CI 1.18-1.72; I2 = 0%) and cancer (n = 1 study; random-effects HR 3.08, 95%CI 1.02-9.03). These risks were independent of age, sex, smoking, body mass index and diabetes (or metabolic syndrome). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias.
CONCLUSIONS:
This meta-analysis of observational studies (involving asymptomatic individuals of predominantly Asian descent undergoing screening colonoscopy) suggests that NAFLD (detected by imaging or biopsy) is independently associated with a moderately increased prevalence and incidence of colorectal adenomas and cancer. However, the observational design of the studies does not allow for proving causality, and the possibility of residual confounding by some unmeasured factors cannot be ruled out. More prospective studies, particularly in European and American individuals, and mechanistic studies are required to better understand the association between NAFLD and colonic carcinogenesis.
0026-0495
1-12
Mantovani, Alessandro
19fc8a1f-60fe-403a-b70e-6b6884929e03
Dauriz, Marco
d9cea036-8d23-4551-b002-f5095f12154e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Lonardo, Amedeo
91124c4f-ae12-4229-8667-58e2c7d3a288
Zoppini, Giacomo
c5c67265-17c7-4dc3-acbb-68e9a9725dc2
Bonora, Enzo
fcd58697-5380-4a8e-87ac-90a138473a4b
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f
Mantovani, Alessandro
19fc8a1f-60fe-403a-b70e-6b6884929e03
Dauriz, Marco
d9cea036-8d23-4551-b002-f5095f12154e
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Lonardo, Amedeo
91124c4f-ae12-4229-8667-58e2c7d3a288
Zoppini, Giacomo
c5c67265-17c7-4dc3-acbb-68e9a9725dc2
Bonora, Enzo
fcd58697-5380-4a8e-87ac-90a138473a4b
Targher, Giovanni
043e0811-b389-4922-974e-22e650212c5f

Mantovani, Alessandro, Dauriz, Marco, Byrne, Christopher, Lonardo, Amedeo, Zoppini, Giacomo, Bonora, Enzo and Targher, Giovanni (2018) Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis. Metabolism, 87, 1-12. (doi:10.1016/j.metabol.2018.06.004).

Record type: Article

Abstract

BACKGROUND:
It is currently uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of colorectal tumours. We performed a meta-analysis of relevant observational studies to quantify the magnitude of the association between NAFLD and risk of colorectal adenomas and cancer.
METHODS:
We searched PubMed, Scopus and Web of Science from January 2000 to November 2017 using pre-defined keywords to identify observational studies of asymptomatic adults undergoing screening colonoscopy, in which NAFLD was diagnosed by imaging or histology. Data from selected studies were extracted and meta-analysis was performed using random-effects modelling.
RESULTS:
Eleven observational studies (8 cross-sectional and 3 longitudinal) with aggregate data on 91,124 asymptomatic adults of predominantly Asian descent (32.1% with NAFLD) accounting for a total of 14,911 colorectal adenomas and 1684 cancers were included in the final analysis. NAFLD was associated with an increased risk of prevalent colorectal adenomas (n = 7 studies using liver imaging techniques; random-effects odds ratio [OR] 1.28, 95%CI 1.11-1.48; I2 = 82.9% or n = 1 study using liver biopsy; random-effects OR 1.61, 95%CI 0.90-2.89) and cancer (n = 4 studies using liver imaging techniques; random-effects OR 1.56, 95%CI 1.25-1.94; I2 = 65.6% or n = 1 study using liver biopsy; random-effects OR 3.04, 95%CI 1.29-7.18). NAFLD was also associated with an increased risk of incident colorectal adenomas (n = 3 studies; random-effects hazard ratio [HR] 1.42, 95%CI 1.18-1.72; I2 = 0%) and cancer (n = 1 study; random-effects HR 3.08, 95%CI 1.02-9.03). These risks were independent of age, sex, smoking, body mass index and diabetes (or metabolic syndrome). Sensitivity analyses did not alter these findings. Funnel plot and Egger's test did not reveal significant publication bias.
CONCLUSIONS:
This meta-analysis of observational studies (involving asymptomatic individuals of predominantly Asian descent undergoing screening colonoscopy) suggests that NAFLD (detected by imaging or biopsy) is independently associated with a moderately increased prevalence and incidence of colorectal adenomas and cancer. However, the observational design of the studies does not allow for proving causality, and the possibility of residual confounding by some unmeasured factors cannot be ruled out. More prospective studies, particularly in European and American individuals, and mechanistic studies are required to better understand the association between NAFLD and colonic carcinogenesis.

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NAFLD_colorectal tumours_R2_tracked_final - Accepted Manuscript
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Table 1_studies characteristics included - Accepted Manuscript
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Table 2_sensitivity analyses - Accepted Manuscript
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Figure 1_PRISMA_R2 - Accepted Manuscript
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Figure 2_R3 version - Accepted Manuscript
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Figure 4_R3 version - Accepted Manuscript
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MOOSE Checklist - Accepted Manuscript
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Table S1_synthax used - Accepted Manuscript
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Table S2_studies characteristics excluded - Accepted Manuscript
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Table S3_NOS - Accepted Manuscript
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More information

Accepted/In Press date: 18 June 2018
e-pub ahead of print date: 20 June 2018
Published date: 1 October 2018

Identifiers

Local EPrints ID: 421941
URI: http://eprints.soton.ac.uk/id/eprint/421941
ISSN: 0026-0495
PURE UUID: 2a2ab98f-3a15-4d4d-a2a8-101f8f9ba1a8
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 11 Jul 2018 16:30
Last modified: 16 Mar 2024 06:47

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Contributors

Author: Alessandro Mantovani
Author: Marco Dauriz
Author: Amedeo Lonardo
Author: Giacomo Zoppini
Author: Enzo Bonora
Author: Giovanni Targher

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