EPH El Biar (ex :Djillali Belkhenchir)

Internal medicine department -Pr.Tebaibia-

Faculty of medicine of Algiers – Algeria -

Dr M Aouadi

Meta-analysis of observational
cohort studies
Objectif :
to quantify the magnitude of the association
between non-alcoholic fatty liver disease
(NAFLD) and risk of extrahepatic cancers.
Design :
 Researchers systematically searched PubMed, Scopus and
Web of Science databases from the inception date to 30
December 2020 using predefined keywords to identify
observational cohort studies conducted in individuals, in
which NAFLD was diagnosed by imaging techniques or
International Classification of Diseases codes.
No studies with biopsy-proven NAFLD were available fo
r the analysis.Meta-analysis was performed using random
- effects modelling.
Results :
10 cohort studies were included with 182 202 middle-aged
individuals (24.8% with NAFLD) and
8485 incident cases of extrahepatic cancers at different
sites over a median follow-up of 5.8 years.
NAFLD was significantly associated with a nearly 1.5 to
two fold increased risk of developing GI cancers
(oesophagus, stomach, pancreas or colorectal cancers
Results :
• Furthermore, NAFLD was associated with an approximately
1.2-fold to 1.5-fold increased risk of developing
lung,breast, gynaecological or urinary system cancers.

• All risks were independent of age, sex, smoking, obesity,

diabetes or other potential confounders.
• The overall heterogeneity for most of the primary pooled
analyses was relatively low. Sensitivity analyses did not altr
these findings. Funnel plots did not reveal any significant
publication bias.
Conclusion :
This large meta-analysis suggests that
NAFLD is associated with a moderately increased long-
term risk of developing extrahepatic cancers over a
median of nearly 6 years (especially GI cancers, breast a
nd gynaecological malignancies).
Further research is required to decipher the complex link
between NAFLD and cancer development.
"This study emphasizes the importance of considering
NAFLD as a systemic disease which is potentially associated
with adverse liver outcomes as well as adverse outcomes
related to other organs such as cardiac and cancers "
"It is currently uncertain whether NAFLD is associated with
an increased risk of extrahepatic cancers simply as a
consequence of the shared metabolic risk factors including
obesity and diabetes,
or whether NAFLD itself may contribute to the development
of extrahepatic cancers, independent of these shared risk
factors,"

senior study author Dr. Giovanni Targher of the department of medicine at the
University of Verona, in Italy.
The current standard practice
is to advise people with NAFLD
to lose weight .
→ This will improve NAFLD,
reduce the risk for cardiovascular
disease, and may reduce the risk
of obesity-related cancers .
THANK YOU