Site-specific risk of colorectal neoplasms in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

PLoS One. 2021 Jan 25;16(1):e0245921. doi: 10.1371/journal.pone.0245921. eCollection 2021.


Background: Many studies have shown that NAFLD is indeed closely related to the occurrence of colon tumors. The aim of this study was to further establish an assessment for the risk associated with NAFLD and the site-specificity of colon tumors.

Methods: We searched the PubMed, Embase, Cochrane, and Scopus databases published from January 1, 1981, to December 15, 2019, assessing the risk of colorectal neoplasms in patients with NAFLD. The primary outcome measure was the incidence of site-specific risk of colorectal neoplasms in patients with NAFLD reported as ORs which pooled under a random-effects model and calculated via Mantel-Haenszel weighting. The study is registered with PROSPERO, number CRD42020162118.

Results: 11 articles (12,081 participants) were included in this meta-analysis. After heterogeneity removed, the overall risk-value pooled for right colon tumors(OR = 1.60,95% CI 1.27-2.01,I2 = 58%,P = 0.02)was higher than the left(OR = 1.39,95% CI 1.11-1.73,I2 = 59%,P = 0.02).However, this outcome was unclear when considering gender differences (Male&Right:OR = 1.05; Male&Left:OR = 1.26; Female&Right: OR = 1.17; Female&Left:OR = 1.17).The incidence of right colon tumors(Asian&Right:OR = 1.56)was obviously higher in Asians with NAFLD than the left (Asian&Left:OR = 1.23),while the risk relevance was similar and moderately associated with an increased risk of incident double-sided colorectal tumors in Europeans (European&Right:OR = 1.47; European&Left:OR = 1.41). The outcome of pathological morphology includes: the advanced adenoma OR = 1.82;the tubular adenoma OR = 1.24;the serrated adenoma OR = 2.16.

Conclusions: NAFLD is associated with a high risk of colon tumors, especially in regard to tumors of the right colon, which are more prevalent in Asian populations.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adenoma / epidemiology*
  • Colorectal Neoplasms / epidemiology*
  • Humans
  • Incidence
  • Non-alcoholic Fatty Liver Disease / epidemiology*
  • Risk
  • Risk Assessment

Grants and funding

This work was supported by National Natural Science Foundation of China [No.81774284]; National Administration of Traditional Chinese Medicine : 2019 Project of building evidence based practice capacity for TCM [No. 2019XZZX-ZL006]; Xinglin Scholor Research Premotion Project of Chengdu University of TCM [No.ZRYY1909]; Science and Technology Development Fund of Hospital of Chengdu University of TCM [No.19LW10].The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.