NAFLD Before Age 50 Years Increases Risk for Early-Onset Colorectal Cancer

Having nonalcoholic fatty liver disease at an early age can increase risk of developing colorectal cancer.

Nonalcoholic fatty liver disease (NAFLD) is associated with developing early-onset colorectal cancer (CRC), especially among individuals aged 50 years and younger, according to study results presented at Digestive Disease Week (DDW), held from May 6 to 9, 2023 in Chicago, Illinois, and virtually.

Researchers conducted a retrospective, population-based cohort study nationwide using a National Health Insurance Corporation Database from January 1, 2009 to December 31, 2009. Participants aged 20 to 49 were included in the study and followed up until 2019. NAFLD was defined as a fatty liver index (FLI) greater than or equal to 60 in the absence of any other liver disease and use of 30 g or more of alcohol daily. Subjects were stratified, according to FLI (NAFLD, ≥60; borderline NAFLD, ≥30 to <60; and control group, <30).

[A]ctive intervention for NAFLD is required for people younger than 50 years to reduce EOCRC risk.

A total of 4,657,825 subjects were included in the study, followed up for an average of 9.3 years. During that time, 2,733 cases of EOCRC were identified among those with NAFLD.

Multivariate regression analysis found the risk of EOCRC higher in the NAFLD group (adjusted HR, 1.24; 95% CI, 1.17-1.31), as well as in the borderline NAFLD group (HR, 1.12; 95% CI, 1.07-1.17).

A dose-response association was seen with FLI and EOCRC risk (P for trend <.0001), particularly left-sided CRC. Additionally, subgroup analysis found EOCRC was more likely to be incident in the male population (aHR, 1.17 vs 0.97) and in those aged 20 to 29 years (aHR, 1.30 vs 1.05 vs 1.17; 20-29 vs 30-39 vs 40-49).

Authors concluded, “NAFLD is positively associated with increased risk of developing EOCRC before age 50 years, particularly in left colon. Therefore, active intervention for NAFLD is required for people younger than 50 years to reduce EOCRC risk.”


Kim S, Lee S, Han K, et al. Association between nonalcoholic fatty liver disease and the risk of early-onset colorectal cancer according to anatomical site: a nationwide population-based cohort study in South Korea. Abstract presented at: DDW 2023; May 6-9, 2023; Chicago, IL. Tu1107