Non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver disease, often coexisting with various metabolic risk factors, which are significantly associated with the risk of various tumors. Dr.Jinshui Pan and ProfessoDr. Shang Weng from the Liver Disease Center of Fujian Medical University Affiliated First Hospital, along with Dr. Meizhu Hong from Mengchao Hepatobiliary Hospital, conducted an analysis and assessment of the global burden of metabolic-related tumors from 1990 to 2019 based on the Global Burden of Disease (GBD) database for 2019. The research paper was published in the journal Med, under Cell Press, with an impact factor of 17 in 2023. Additionally, these findings were selected for presentation at the 58th Annual Meeting of the European Association for the Study of the Liver (EASL 2023) and the EASL Congress 2023.
Research Introduction:
The Global Burden of Disease (GBD) database collected data since 1990 from over 9,000 researchers in 162 countries, reporting premature death and disability due to 370 diseases and injuries in 204 countries and regions, categorized by age and gender. Based on GBD 2019, the study stratified and analyzed the Disability-Adjusted Life Years (DALY) rate attributed to metabolic risk factors for tumors in various countries and regions over the past 30 years, considering factors such as metabolic risk, gender, age, tumor type, geographical area, and socio-economic development status (SDI), to assess the characteristics of the global burden of metabolic-related tumors.
As shown in the figure, compared to environmental and behavioral factors, metabolic risk factors have become important contributors to tumor occurrence. Among metabolic risk factors, high Body Mass Index (BMI) and high fasting plasma glucose (FPG) are the two most relevant factors associated with common tumors, significantly increasing the risk of tumor occurrence. In 2019, DALYs caused by metabolic risk factors related to tumors reached 234 per 100,000 person-years.
The most common metabolic-related tumors are colorectal cancer (CRC), trachea and bronchus lung cancer (TBLC), esophageal cancer (EC), breast cancer (BC), liver cancer (LC), and pancreatic cancer (PC). DALYs for metabolic-related colorectal cancer increased from 1.41 million person-years in 1990 to 3.75 million person-years in 2019, while DALYs for metabolic-related trachea and bronchus lung cancer increased from 1.51 million person-years to 3.64 million person-years. High BMI and high FPG have significant impacts on CRC, BC, and PC, with high FPG having a greater impact on TBLC, and high BMI having a greater impact on EC and LC.
Metabolic-related tumor incidence is higher in males and those over 50 years of age. In 2019, DALYs for metabolic-related tumors were 10.44 million person-years for males and 8.97 million person-years for females. Furthermore, there is a positive correlation between the burden of metabolic-related tumors and socio-economic development status (SDI), meaning that higher SDI is associated with a heavier burden of metabolic-related tumors. In 2019, CRC DALYs in high SDI areas were 1.16 million person-years, and in middle-high SDI areas, they were 1.18 million person-years. Metabolic-related TBLC DALYs in high SDI areas were 1.14 million person-years, and in middle-high SDI areas, they were 1.03 million person-years.
In conclusion,This study reveals the heavy burden of tumors caused by metabolic risk factors on a global scale, further confirming the association between NAFLD and the occurrence of both intrahepatic and extrahepatic tumors. It underscores the need to develop targeted screening strategies for common tumors among high-risk NAFLD populations.
Researchers’ Remarks:
Given the changing lifestyle habits, diet, and living environments in contemporary society, metabolic abnormalities have become a high-risk factor for multiple significant diseases. Metabolic-related tumors have also become a global health concern. Since the contribution of metabolic risk factors to the global burden of common tumors is still poorly understood, it is crucial to assess the burden of tumor diseases in different gender, age, tumor types, regions, and socio-economic development statuses to develop more targeted screening strategies for high-risk populations.
Currently, the average global prevalence of metabolic syndrome is 13.61%, and in China, it ranges from 14% to 18%, significantly higher than the global average. Furthermore, under similar dietary conditions, Asians are more susceptible to metabolic syndrome than Europeans and Americans, highlighting the disease risk of metabolic-related tumors among the Chinese population. High Body Mass Index (BMI) can induce a pro-inflammatory endocrine environment, producing a large number of inflammatory mediators, altering signaling between adipocytes, immune cells, and epithelial cells, leading to the overactivation of adipose tissue macrophages and upregulation of carcinogenic compounds, ultimately creating a carcinogenic environment. High fasting plasma glucose (FPG) is a manifestation of insulin resistance, and insulin-like growth factor-1 (IGF-1) can increase vascular endothelial growth factor (EGFR), vascular endothelial growth factor (VEGF), etc., promoting rapid neovascularization and increased proliferation of vascular endothelium, thereby accelerating tumor progression.
However, the specific mechanisms of metabolic-related tumors are still unclear, and our team plans to conduct further research on the related pathogenesis. If conditions permit, we will also conduct prospective cohort studies to further clarify the contribution of metabolic risk factors to the burden of tumors.
Corresponding Author:
Liver Disease Center, Fujian Medical University Affiliated First Hospital.
First Author:
Fujian Medical University, Ph.D. candidate.
