Risk of Early-Onset Digestive Tract Cancers Among Young Adults With Nonalcoholic Fatty Liver Disease

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In a Korean nationwide cohort study reported in the Journal of Clinical Oncology, Park et al found that individuals aged 20 to 39 years with nonalcoholic fatty liver disease (NAFLD) were at an increased risk of developing early-onset digestive tract cancers.

Study Details

The study included data on 5,265,590 individuals aged 20 to 39 years who underwent national health screening under the Korean National Health Insurance Service between 2009 and 2012. Participants were followed through December 2018 to determine the incidence of early-onset digestive tract cancers (esophageal, stomach, colorectal, liver, pancreatic, biliary tract, and gallbladder cancers) diagnosed at age 20 to 49 years among those with vs without NAFLD.

Key Findings

At baseline, 25.4% (n = 1,336,571) of individuals had NAFLD. During 38.8 million person-years of follow-up, 14,565 patients were newly diagnosed with early-onset digestive tract cancers.

The cumulative incidence probability of each cancer type was consistently higher in individuals with vs without NAFLD (all P < .05). The incidence rates per 100,000 person-years for NAFLD vs no NAFLD were 46.2 vs 36.5 for overall digestive cancers, 0.4 vs 0.2 for esophageal cancer, 17.8 vs 13.1 for stomach cancer, 23.3 vs 19.4 for colorectal cancer, 5.7 vs 2.5 for liver cancer, 7.4 vs 5.4 for pancreatic cancer, 1.6 vs 1.0 for biliary tract cancer, and 0.6 vs 0.3 for gallbladder cancer.

On multivariate analysis adjusting for age, sex, body mass index, smoking status, alcohol consumption, physical activity, income status, diabetes, pancreatitis, and cholangitis, NAFLD was associated with a significantly increased risk of overall digestive tract cancers (adjusted hazard ratio [aHR] = 1.16, 95% confidence interval [CI] = 1.10–1.22), stomach cancer (aHR = 1.14, 95% CI = 1.06–1.24), colorectal cancer (aHR = 1.14, 95% CI = 1.06–1.22), liver cancer (aHR = 1.13, 95% CI = 1.12–1.52), pancreatic cancer (aHR = 1.23, 95% CI = 1.09–1.40), biliary tract cancer (aHR = 1.29, 95% CI = 1.00–1.66), and gallbladder cancer (aHR = 1.53, 95% CI = 1.01–2.31). The adjusted hazard ratio for esophageal cancer was not significant (1.67, 95% CI = 0.92–3.03).

The investigators concluded, “NAFLD may be an independent, modifiable risk factor for [early]-onset digestive tract cancers. Our findings suggest a crucial opportunity to reduce premature morbidity and mortality associated with [early]-onset digestive tract cancers in the next generation.”

Jung Yong Hong, MD, PhD, of Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Basic Science Research Program through the National Research Foundation of Korea and Future Medicine 2030 Project of the Samsung Medical Center. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.