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- Title
Extrahepatic malignancies in metabolic dysfunction‐associated fatty liver disease: A nationwide cohort study.
- Authors
Park, Min Kyung; Hur, Moon Haeng; Moon, Hye‐Sung; Shin, Hyunjae; Chung, Sung Won; Won, Sungho; Lee, Yun Bin; Cho, Eun Ju; Lee, Jeong‐Hoon; Yu, Su Jong; Yoon, Jung‐Hwan; Kim, Yoon Jun
- Abstract
Background and Aims: Metabolic dysfunction‐associated fatty liver disease (MAFLD) encompasses heterogeneous fatty liver diseases associated with metabolic disorders. We aimed to evaluate the association between MAFLD and extrahepatic malignancies based on MAFLD subtypes. Methods: This nationwide cohort study included 9 298 497 patients who participated in a health‐screening programme of the National Health Insurance Service of Korea in 2009. Patients were further classified into four subgroups: non‐MAFLD, diabetes mellitus (DM)‐MAFLD, overweight/obese‐MAFLD and lean‐MAFLD. The primary outcome was the development of any primary extrahepatic malignancy, while death, decompensated liver cirrhosis and liver transplantation were considered competing events. The secondary outcomes included all‐cause and extrahepatic malignancy‐related mortality. Results: In total, 2 500 080 patients were diagnosed with MAFLD. During a median follow‐up of 10.3 years, 447 880 patients (6.0%) with extrahepatic malignancies were identified. The DM‐MAFLD (adjusted subdistribution hazard ratio [aSHR] = 1.13; 95% confidence interval [CI] = 1.11–1.14; p <.001) and the lean‐MAFLD (aSHR = 1.12; 95% CI = 1.10–1.14; p <.001) groups were associated with higher risks of extrahepatic malignancy than the non‐MAFLD group. However, the overweight/obese‐MAFLD group exhibited a similar risk of extrahepatic malignancy compared to the non‐MAFLD group (aSHR = 1.00; 95% CI =.99–1.00; p =.42). These findings were reproduced in several sensitivity analyses. The DM‐MAFLD was an independent risk factor for all‐cause mortality (adjusted hazard ratio [aHR] = 1.41; 95% CI = 1.40–1.43; p <.001) and extrahepatic malignancy‐related mortality (aHR = 1.20; 95% CI = 1.17–1.23; p <.001). Conclusion: The diabetic or lean subtype of MAFLD was associated with a higher risk of extrahepatic malignancy than non‐MAFLD. As MAFLD comprises a heterogeneous population, appropriate risk stratification and management based on the MAFLD subtypes are required.
- Subjects
SOUTH Korea; FATTY liver; NATIONAL health insurance; COHORT analysis; MORTALITY risk factors; CIRRHOSIS of the liver
- Publication
Liver International, 2024, Vol 44, Issue 3, p799
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.15832