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Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of extrahepatic cancer
  1. Christoph Roderburg1,
  2. Karel Kostev2,
  3. Alexander Mertens1,
  4. Tom Luedde1,
  5. Sven H Loosen1
  1. 1 Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
  2. 2 Epidemiology, IQVIA, Frankfurt, Germany
  1. Correspondence to Dr Sven H Loosen, Clinic for Gastroenterology, Hepatology and Infectious Diseases, Universitätsklinikum Düsseldorf, Dusseldorf, Germany; Sven.Loosen{at}

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With great interest, we read the meta-analysis of observational cohort studies by Mantovani et al 1 providing significant evidence for an increased long-term risk of developing certain extrahepatic malignancies (especially gastrointestinal (GI), breast and gynaecological cancers) in patients with non-alcoholic fatty liver disease (NAFLD). Given the dramatically increasing global relevance of NAFLD, which currently has a prevalence of 25%,2–4 these findings are of immense clinical importance and may lead to prevention and screening algorithms.

In a retrospective cohort study, we identified 86 777 NAFLD patients (International Classification of Diseases (Version 10) (ICD-10): K75.8, K76.0) and a matched cohort of equal size without NAFLD from the Disease Analyzer database (IQVIA) compiling diagnoses and demographic data from general practitioners in Germany (online supplemental figure 1).5 Propensity score matching included the following variables: sex, age, index year, yearly consultation frequency, diabetes (ICD-10: E10–E14), obesity (ICD-10: E00–E07), thyroid gland disorders (ICD-10: E00–E07), chronic bronchitis and chronic obstructive pulmonary disease (COPD) (ICD-10: J42–J44) diagnoses. Mean age was 57.7 years. 46.4% of patients were female (online supplemental table 1). Incidence of extrahepatic malignancies was analysed as a …

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  • TL and SHL are joint senior authors.

  • CR and KK are joint first authors.

  • Contributors SHL, KK and CR designed the study, KK performed statistical analyses and generated figures and tables, SHL and CR wrote the manuscript, TL and AM provided intellectual input, all authors agreed to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.