Non-Obese MAFLD Is Associated with Colorectal Adenoma in Health Check Examinees: A Multicenter Retrospective Study

Colorectal adenoma is linked to metabolic dysfunction. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a precise definition and three subtypes, including non-obese MAFLD. We aimed to investigate the impact of MAFLD on the prevalence of colorectal adenoma by comparing it to non-alcoholic fatty liver disease (NAFLD) in health check-up examinees. This is a multicenter retrospective study. We enrolled 124 consecutive health check-up examinees who underwent colonoscopy. NAFLD and MAFLD were present in 58 and 63 examinees, respectively. Colorectal adenoma was diagnosed by biopsy. The impact of the MAFLD definition on the prevalence of colorectal adenoma was investigated by logistic regression, decision-tree, and random forest analyses. In logistic regression analysis, MAFLD was identified as the only independent factor associated with the presence of colorectal adenoma (OR 3.191; 95% CI 1.494–7.070; p = 0.003). MAFLD was also identified as the most important classifier for the presence of colorectal adenoma in decision-tree and random forest analyses (29 variable importance value). Among the three subtypes of MAFLD, non-obese MAFLD was the sole independent factor associated with the presence of colorectal adenoma (OR 3.351; 95% CI 1.589–7.262; p ≤ 0.001). Non-obese MAFLD was also the most important classifier for the presence of colorectal adenoma in decision-tree and random forest analyses (31 variable importance value). MAFLD, particularly non-obese MAFLD, is the most important factor associated with the presence of colorectal adenoma rather than NAFLD. Colonoscopy examination should be considered in patients with MAFLD, especially those who are non-obese.

[1]  Yong‐ho Lee,et al.  Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study. , 2020, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[2]  M. Zheng,et al.  MAFLD and risk of CKD. , 2020, Metabolism: clinical and experimental.

[3]  V. Wong,et al.  The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease , 2020, Hepatology International.

[4]  T. Kawaguchi,et al.  MAFLD identifies patients with significant hepatic fibrosis better than NAFLD , 2020, Liver international : official journal of the International Association for the Study of the Liver.

[5]  Masakazu Yamamoto,et al.  Clinical and anthropometric characteristics of non‐obese non‐alcoholic fatty liver disease subjects in Japan , 2020, Hepatology research : the official journal of the Japan Society of Hepatology.

[6]  Wenxia Chen,et al.  High risk of colorectal polyps in men with non‐alcoholic fatty liver disease: A systematic review and meta‐analysis , 2020, Journal of gastroenterology and hepatology.

[7]  Jiaofeng Huang,et al.  Comparison of MAFLD and NAFLD diagnostic criteria in real world , 2020, Liver international : official journal of the International Association for the Study of the Liver.

[8]  C. Stave,et al.  Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. , 2020, The lancet. Gastroenterology & hepatology.

[9]  Shuohua Chen,et al.  Associations Between Nonalcoholic Fatty Liver Disease and Cancers in a Large Cohort in China. , 2020, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[10]  Type 2 diabetes impacts colorectal adenoma detection in screening colonoscopy , 2020, Scientific Reports.

[11]  C. Sohn,et al.  Skeletal muscle mass and risk of advanced adenoma in surveillance colonoscopy , 2020, Journal of gastroenterology and hepatology.

[12]  V. Wong,et al.  A new definition for metabolic associated fatty liver disease: an international expert consensus statement. , 2020, Journal of hepatology.

[13]  E. Vogtmann,et al.  Fecal Metabolomic Signatures in Colorectal Adenoma Patients Are Associated with Gut Microbiota and Early Events of Colorectal Cancer Pathogenesis , 2020, mBio.

[14]  T. Kawaguchi,et al.  Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees , 2020, Hepatology research : the official journal of the Japan Society of Hepatology.

[15]  G. Marchesini,et al.  Lean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation , 2020, Hepatology.

[16]  G. Filippatos,et al.  2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. , 2020, European heart journal.

[17]  F. Cosentino,et al.  The 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. , 2019, European heart journal.

[18]  T. Kawaguchi,et al.  High serum interleukin‐34 level is a predictor of poor prognosis in patients with non‐viral hepatocellular carcinoma , 2019, Hepatology research : the official journal of the Japan Society of Hepatology.

[19]  M. Sabatine,et al.  2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. , 2019, European heart journal.

[20]  Y. Xin,et al.  Association between NAFLD and Risk of Colorectal Adenoma in Chinese Han Population , 2019, Journal of clinical and translational hepatology.

[21]  H. Arakawa,et al.  Metagenomic analyses of the gut microbiota associated with colorectal adenoma , 2019, PloS one.

[22]  Guo Xinru,et al.  2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension: Erratum. , 2019, Journal of hypertension.

[23]  E. Bonora,et al.  Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis. , 2018, Metabolism: clinical and experimental.

[24]  A. Jemal,et al.  Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries , 2018, CA: a cancer journal for clinicians.

[25]  T. Okamura,et al.  Fatty liver index predicts incident diabetes in a Japanese general population with and without impaired fasting glucose , 2018, Hepatology research : the official journal of the Japan Society of Hepatology.

[26]  Hirokazu Takahashi,et al.  A Data Mining-based Prognostic Algorithm for NAFLD-related Hepatoma Patients: A Nationwide Study by the Japan Study Group of NAFLD , 2018, Scientific Reports.

[27]  Michael Charlton,et al.  The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases , 2018, Hepatology.

[28]  A. Gasbarrini,et al.  Gut microbiome composition in lean patients with NASH is associated with liver damage independent of caloric intake: A prospective pilot study. , 2017, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[29]  D. Chang,et al.  Obesity-related parameters and colorectal adenoma development , 2017, Journal of Gastroenterology.

[30]  H. Tilg,et al.  EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. , 2016, Journal of hepatology.

[31]  European Association for the Study of the Liver,et al.  EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease , 2016, Obesity Facts.

[32]  E. Gruszewska,et al.  The Distribution of Liver Steatosis, Fibrosis, Steatohepatitis and Inflammation Activity in Alcoholics According to FibroMax Test. , 2015, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[33]  T. Saibara,et al.  Evidence‐based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis , 2015, Hepatology research : the official journal of the Japan Society of Hepatology.

[34]  Kefu Zhu,et al.  Systematic review with meta‐analysis: alcohol consumption and the risk of colorectal adenoma , 2014, Alimentary pharmacology & therapeutics.

[35]  W. Chan,et al.  Patients with nonalcoholic fatty liver disease have higher risk of colorectal adenoma after negative baseline colonoscopy , 2013, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[36]  Paolo Chiodini,et al.  Metabolic Syndrome and Risk of Cancer , 2012, Diabetes Care.

[37]  Qiwen Ben,et al.  Body mass index increases risk for colorectal adenomas based on meta-analysis. , 2012, Gastroenterology.

[38]  Association of colorectal adenoma with components of metabolic syndrome , 2012, Cancer Causes & Control.

[39]  A. Zauber,et al.  Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. , 2012, The New England journal of medicine.

[40]  A. Stadlmayr,et al.  Nonalcoholic fatty liver disease: an independent risk factor for colorectal neoplasia , 2011, Journal of internal medicine.

[41]  V. Wong,et al.  High prevalence of colorectal neoplasm in patients with non-alcoholic steatohepatitis , 2011, Gut.

[42]  M. Taskinen,et al.  [ESC/EAS Guidelines for the management of dyslipidaemias]. , 2011, Revista espanola de cardiologia.

[43]  T. Poynard,et al.  Noninvasive biomarkers for the screening of fibrosis, steatosis and steatohepatitis in patients with metabolic risk factors: FibroTest-FibroMax experience. , 2008, Journal of gastrointestinal and liver diseases : JGLD.

[44]  T. Poynard,et al.  FibroMAX™: towards a new universal biomarker of liver disease? , 2007, Expert review of molecular diagnostics.

[45]  Yoon-Ho Choi,et al.  Is Metabolic Syndrome A Risk Factor for Colorectal Adenoma? , 2007, Cancer Epidemiology Biomarkers & Prevention.

[46]  J. Johanson,et al.  Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. , 2006, The New England journal of medicine.

[47]  J. Montaner,et al.  Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection , 2006, Hepatology.

[48]  J. Hardcastle,et al.  Colorectal cancer , 1993, Europe Against Cancer European Commission Series for General Practitioners.

[49]  H. Bussey,et al.  ÆTIOLOGY OF ADENOMA—CARCINOMA SEQUENCE IN LARGE BOWEL , 1978, The Lancet.