title: Risk of cancer in patients hospitalized with fatty liver: a Danish cohort study.
abstract: OBJECTIVE
  To examine the risk of cancer in patients with fatty liver.
  
  
  BACKGROUND
  The relation between liver disease, including fatty liver, and cancer risk is poorly understood.
  
  
  METHODS
  Using the population-based National Registry of Patients, we examined the incidence of cancer in 7,326 patients discharged with a diagnosis of fatty liver from a Danish hospital during 1977-1993. Patients with a prior diagnosis of liver cirrhosis were excluded. We identified cancers through the Danish Cancer Registry. The expected number of cancers was estimated from national age-, sex-, and site-specific incidence rates.
  
  
  RESULTS
  Overall, 523 cancers were diagnosed during 47,594 person-years of follow-up, yielding a 1.7-fold increased risk (95% confidence interval, 1.6-1.9) compared with the Danish general population. The risk of primary liver cancer was markedly elevated in patients with alcoholic as well as nonalcoholic fatty liver with a standardized incidence ratio of 9.5 (95% confidence interval, 5.7-14.8) and 4.4 (95% confidence interval, 1.2-11.4), respectively. Patients with alcoholic fatty liver also had substantially increased risks of several types of cancer associated with alcohol and tobacco use (cancers of the lung, pharynx, larynx, esophagus, and stomach) and a moderately increased risk for cancers of the colon and breast. Among patients with nonalcoholic fatty liver, an increased risk of some alcohol- and tobacco-related cancers was seen, and there was also an increased risk of colon and pancreas cancer.
  
  
  CONCLUSIONS
  Patients discharged with a diagnosis of fatty liver have an increased risk of cancer, in particular liver cancer, most prominently among patients with alcoholic fatty liver.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. hts@soci.au.dk
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.forename: Lene
authors.initials: L
authors.lastname: Mellemkjaer
authors.forename: Peter
authors.initials: P
authors.lastname: Jepsen
authors.forename: Ane Marie
authors.initials: AM
authors.lastname: Thulstrup
authors.forename: John
authors.initials: J
authors.lastname: Baron
authors.forename: Jørgen H
authors.initials: JH
authors.lastname: Olsen
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
mesh_terms: D017677:Age Distribution; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology*; D005235:Fatty Liver, Alcoholic / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution