title: Association of nonalcoholic fatty liver disease and liver cancer.
abstract: OBJECTIVE
  To investigate the association between nonalcoholic fatty liver disease (NAFLD) and liver cancer, and NAFLD prevalence in different liver tumors.
  
  
  METHODS
  This is a retrospective study of the clinical, laboratory and histological data of 120 patients diagnosed with primary or secondary hepatic neoplasms and treated at a tertiary center where they underwent hepatic resection and/or liver transplantation, with subsequent evaluation of the explant or liver biopsy. The following criteria were used to exclude patients from the study: a history of alcohol abuse, hepatitis B or C infection, no tumor detected in the liver tissue examined by histological analysis, and the presence of chronic autoimmune hepatitis, hemochromatosis, Wilson's disease, or hepatoblastoma. The occurrence of NAFLD and the association with its known risk factors were studied. The risk factors considered were diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, body mass index, dyslipidemia, and arterial hypertension. Presence of reticulin fibers in the hepatic neoplasms was assessed by histological analysis using slide-mounted specimens stained with either hematoxylin and eosin or Masson's trichrome and silver impregnation. Analysis of tumor-free liver parenchyma was carried out to determine the association between NAFLD and its histological grade.
  
  
  RESULTS
  No difference was found in the association of NAFLD with the general population (34.2% and 30.0% respectively, 95%CI: 25.8-43.4). Evaluation by cancer type showed that NAFLD was more prevalent in patients with liver metastasis of colorectal cancer than in patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma (OR = 3.99, 95%CI: 1.78-8.94, P < 0.001 vs OR = 0.60, 95%CI: 0.18-2.01, P = 0.406 and OR = 0.70, 95%CI: 0.18-2.80, P = 0.613, respectively). There was a higher prevalence of liver fibrosis in patients with hepatocellular carcinoma (OR = 3.50, 95%CI: 1.06-11.57, P = 0.032). Evaluation of the relationship between the presence of NAFLD, nonalcoholic steatohepatitis, and liver fibrosis, and their risk factors, showed no significant statistical association for any of the tumors studied.
  
  
  CONCLUSIONS
  NAFLD is more common in patients with liver metastases caused by colorectal cancer.
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Perla Oliveira
authors.initials: PO
authors.lastname: Schulz
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Fabio Gonçalves
authors.initials: FG
authors.lastname: Ferreira
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Maria de Fátima Araújo
authors.initials: Mde F
authors.lastname: Nascimento
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vieira
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Mauricio Alves
authors.initials: MA
authors.lastname: Ribeiro
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: André Ibrahim
authors.initials: AI
authors.lastname: David
authors.affiliation: Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil.
authors.forename: Luiz Arnaldo
authors.initials: LA
authors.lastname: Szutan
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers
keywords: Colorectal liver metastases; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Liver fibrosis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis