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With great interest, we read the review by Targher et al,1 which eloquently describes the intricate link among metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), obesity, systemic inflammation and the increased risk of extrahepatic cancers. The review underscores the essential roles of insulin resistance and chronic low-grade inflammation in heightening the risk of extrahepatic malignancies in MASLD. MASLD and obesity are often considered ‘brothers in arms,’ sharing a bidirectional relationship that exacerbates each condition.2 Here, we would like to highlight an intriguing observation from our recent study. Contrary to the commonly held belief that obesity is associated with worse cancer prognosis, we observed that obese patients with MASLD with extrahepatic cancer tend to experience improved survival rates. This observation challenges the simplistic view of the obesity paradox and underscores the need for a more comprehensive understanding of these interconnected conditions.
Our analysis used data from the National Health and Nutrition Examination Survey (NHANES), encompassing 5139 patients from the 1999–2018 datasets, with a median follow-up period of 7.74 years (figure 1A and online supplemental table S1). We initially employed restricted cubic spline curves to examine the association between various obesity-related indices (body mass index (BMI), abdominal volume index (AVI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR)) and all-cause mortality after adjusting for age, gender and race. The classical obesity paradox, …
Footnotes
Contributors WL: Conceptualisation, methodology, data curation, software and writing—review and editing. WW: Funding acquisition, project administration, supervision and validation. The work reported in the paper has been performed by the authors, unless clearly specified in the text.
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.
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