Non-alcoholic fatty liver disease (NAFLD) increases the likelihood of developing cancer. Now a new study shows that the younger people develop NAFLD, the greater their cancer risk. 

Researchers from China matched 31,848 NAFLD patients with the same number of controls. The average age was 51.4 years and 17.2 per cent were female. During a median follow-up of 10.16 years, 1,281 NAFLD patients and 1,134 controls developed cancer. 

Compared with controls, patients younger than 45 years and 45-54 years at NAFLD onset showed a 52 and 50 per cent higher cancer risk respectively. Among the same patients, malignancies of the digestive system doubled (adjusted hazard ratio [HR] 2.00 and 1.94 respectively). 

Among patients younger than 45 years at NAFLD onset, the risk of liver (HR 2.66) and lung cancers (HR 2.14) more than doubled. In those younger than 45 years, NAFLD accounted for 17.8 per cent of all cancers.

The difference in cancer risk among older people was not statistically significant. The authors suggest that “timely intervention in the progression of NAFLD may be associated with decreased incidence of NAFLD-related cancers and reduced burden on public health”. (JAMA Network Open 2023; 6:e2335511)

...and pharmacists can help identify those at risk

In a recent review, Majid Mufaqam Syed-Abdul from the University of Toronto argues that community pharmacists can help identify people at high risk of developing NAFLD. 

This can be done, he says, by using variables such as:

• Anthropometrics (e.g. BMI, waist-hip ratio) – obesity increases NAFLD risk 
• Family, medical and medication history: type 2 diabetes, for example, raises NAFLD risk
• Blood biomarkers (e.g. increased alanine transaminase, triglycerides, gamma-glutamyl transferase and HbA1c) also raise risk. 

Pharmacists could, for example, promote a ‘liver health clinic’ when patients collect prescriptions, counsel and educate patients, and refer for formal diagnosis as appropriate.

“By collaborating with other healthcare professionals and adopting a proactive approach, pharmacists can make significant contributions to the early detection and effective management of NAFLD, ultimately improving patient outcomes and advancing liver health within the community,” Syed-Abdul comments. (Pharmacy 2023; 11:151)