Non-obese or lean non-alcoholic fatty liver disease was associated with increased risk of cancer in patients with type 2 diabetes mellitus

Sep 24, 2026

Study evaluates the independent relationship between non-obese or lean non-alcoholic fatty liver disease (NAFLD) and cancer risk among patients with type 2 diabetes mellitus (T2DM), and assesses whether body mass index (BMI) modifies this association. Cross-sectional baseline analyses were performed in 233 patients in Xiamen, China. NAFLD was defined by ultrasound steatosis without excessive alcohol use and without viral or autoimmune liver disease, and fibrosis severity was quantified by FIB-4. NAFLD showed higher cancer prevalence and increased adjusted odds of cancer; BMI and FIB-4 were not significant modifiers, supporting strengthened screening and management.

LanguageEnglish

CategoryResearch & Report

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Pages9

Reading Time23 min

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Abstract

Introduction

Research design and methods

Results

Conclusions

Background context

Open access Original research To cite: Chen N, Zhou J, Wang K, et al. Non-obese or lean non-alcoholic fatty liver disease was associated with increased risk of cancer inpatients with type 2 diabetes mellitus. BMJ Open Diab Res Care 2023;11:e003066 . doi:10.1136/ bmjdrc-2022-003066 NC and JZ contributed equally. Received 25 July 2022 Accepted 31 January 2023 © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 1Department of Endocrinology, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen, Fujian, China 2Department of Endocrinology, Fudan University Xiamen Branch, Xiamen, Fujian, China 3Department of Endocrinology, Fudan University Shanghai, Yangpu, Shanghai, China 4Epidemiology Research Unit, Translational Medicine Research Center, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China Correspondence to Dr Zhibin Li; zhibinli33@hotmail.com and Dr Xiaoying Li; [li.xiaoying@zs-hospital.sh.cn](li.xiaoying@zs-hospital.sh.cn) Non-obese or lean non-alcoholic fatty liver disease was associated with increased risk of cancer in patients with type 2 diabetes mellitus Ning Chen,1 Jingqi Zhou,1 Kai Wang,1 Xiaoying Li,2,3 Zhibin Li 4 ABSTRACT Introduction Risk of non-obese or lean non-alcoholic fatty liver disease (NAFLD) for cancer in patients with type 2 diabetes mellitus (T2DM) is less known. We aimed to evaluate independent associations of NAFLD, especially non-obese or lean NAFLD, and body mass index (BMI) on risks of cancer in patients with T2DM. Research design and methods Cross-sectional analyses of baseline information on a cohort of 233 patients with T2DM were conducted in Xiamen, China. NAFLD was identified by hepatic ultrasonography diagnosis of hepatic steatosis without excessive alcohol consumption, viral or autoimmune liver disease. Fibrosis-4 (FIB-4) score was calculated to quantify severity of hepatic fibrosis. Results All types of cancers were diagnosed on 19 (8 .2%) patients. Prevalence of cancer was significantly higher in those with NAFLD than those without (15 .5% vs 4 .0%, p=0 .002), but were not significantly different among BMI categories (6 .8%, 13.7% and 6.5% for those with underweight or normal weight (n=74), overweight (n=51) and obesity (n=108), respectively, p=0 .258) . With adjustment for potential confounding factors in the multivariable logistic regression models, NAFLD was significantly associated with increased risk of cancer with the adjusted OR (95% CI) of 5.969 (1.349 to 26.413, p=0 .019) . Stratified analyses across BMI categories found similar association of NAFLD with risk of cancer for those non-obese or lean (the adjusted OR (95% CI) 17.446 (1 .690 to 180 .095, p=0 .016)) but not for those with either overweight (OR (95% CI) 11.642 (0 .832 to 162.963, p=0.068) or obesity (OR (95% CI) 0.917 (0.170 to 4.954, p=0.920). FIB-4 score was not significantly associated with risk of cancer for all subjects or stratified across BMI categories. BMI was not significantly associated with risk of cancer for all patients or stratified by NAFLD. Conclusions NAFLD, even non-obese or lean NAFLD, was independently associated with increased risk of cancer in patients with T2DM. Screening and management of NAFLD, especially for those with underweight or normal weight, should be strengthened from the perspective of improving prevention and management of cancer inpatients with T2DM. The global prevalence of diabetes was estimated to be 9.3%(463 million people) in 2019 and would rise to 10.2%(578 million) by 2030 and 10.9%(700 million) by 2045.1–3 WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ Risk of non-obese or lean non-alcoholic fatty liver disease (NAFLD) for cancer in patients with type 2 diabetes mellitus (T2DM) is less known.
WHAT THIS STUDY ADDS | | --- | | ⇒ The prevalence rate of cancer was significantly higher in those with NAFLD than those without (15 .5% vs

FAQs

What was the study aiming to evaluate in patients with type 2 diabetes mellitus?

The study aimed to assess independent associations between NAFLD (especially non-obese or lean NAFLD) and cancer risk in patients with T2DM, and to examine the role of BMI.

How was NAFLD defined for this research?

NAFLD was identified using hepatic ultrasonography showing hepatic steatosis, without excessive alcohol consumption and without viral or autoimmune liver disease.

What were the main findings regarding cancer risk?

Cancer prevalence was higher in patients with NAFLD than those without, and NAFLD was significantly associated with increased cancer risk after multivariable adjustment; BMI and FIB-4 were not significantly associated with cancer risk.

Sep 24, 2026

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