title: Absence of non-alcoholic fatty liver disease in the presence of insulin resistance is a strong predictor for colorectal carcinoma.
abstract: BACKGROUND
  Colorectal carcinoma (CRC) and non-alcoholic fatty liver disease (NAFLD) share common risk factors. Insulin resistance (IR) has an important role in both diseases. It has been speculated that the prevalence of colorectal neoplasms might be increased in patients with NAFLD. However, It is unclear whether NAFLD is an actual risk factor or any association is incidental coexistance due to the role of IR in both disease. We aimed to assess the risk for CRC in patients with NAFLD in relation to IR.
  
  
  METHODS
  This study was designed prospectively and cross-sectionally. We determined NAFLD by ultrasonography and measured IR by the homeostatic model of assessment-insulin resistance model.
  
  
  RESULTS
  The prevalences of CRC and adenoma were shown to be significantly higher in patients with IR (respectively; P: 0.005, P: 0.008). But prevalence of CRC was found to be significantly lower in subjects with NAFLD (P: 0.001). On multivariate logistic regression analysis, the risks of colorectal adenoma and carcinoma were significantly associated with the presence of IR (respectively; OR: 2.338, 95% CI: 1.080-4.993, P: 0.003 and : 5.023, 95% CI: 1.789-9.789, P: 0.001). The risk for CRC was significantly associated with the absence of NAFLD (OR: 7.380, 95% CI: 3.069-7.961, P: 0.010). The absence of NAFLD in the presence of IR was associated with significantly high risk for CRC (OR: 5.218, 95% CI: 1.538-7.448, P: 0.017).
  
  
  CONCLUSIONS
  The risk of CRC can increased in subjects with IR but without NAFLD. The absence of NAFLD in the presence of IR may predict the CRC.
authors.affiliation: Department of Gastroenterology, Kecioren Research and Training Hospital Ankara, Turkey.
authors.forename: Sebahat
authors.initials: S
authors.lastname: Basyigit
authors.affiliation: Department of Gastroenterology, Kecioren Research and Training Hospital Ankara, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Uzman
authors.affiliation: Department of Gastroenterology, Siirt State Hospital Siirt, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Kefeli
authors.affiliation: Department of Gastroenterology, Kecioren Research and Training Hospital Ankara, Turkey.
authors.forename: Ferdane Pirincci
authors.initials: FP
authors.lastname: Sapmaz
authors.affiliation: Department of Gastroenterology, Gaziosmanpasa Universtiy, Faculty of Medicine Tokat, Turkey.
authors.forename: Abdullah Ozgür
authors.initials: AO
authors.lastname: Yeniova
authors.affiliation: Department of Gastroenterology, Kecioren Research and Training Hospital Ankara, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Nazligul
authors.affiliation: Department of Internal Medicine, Kecioren Research and Training Hospital Ankara, Turkey.
authors.forename: Zeliha
authors.initials: Z
authors.lastname: Asiltürk
keywords: Colonoscopy; cancer pathogenesis; colorectal neoplasm screening; hepatosteatosis; insulin resistance