Sex-specific co-occurrence patterns of Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease among patients with colorectal cancer: a retrospective EMR-based series.

BACKGROUND: Colorectal cancer (CRC) is a major global health burden and one of the most prevalent malignancies worldwide. Its association with metabolic comorbidities is receiving increasing attention. Type 2 Diabetes Mellitus (T2DM) and Non-Alcoholic Fatty Liver Disease (NAFLD) are two interrelated metabolic disorders increasingly implicated in CRC pathogenesis, possibly via insulin resistance, chronic inflammation, oxidative stress, and gut-liver axis dysregulation. However, limited evidence exists on their co-occurrence and sex-specific distribution among CRC patients, particularly within real-world clinical settings in Asian populations. This study explored the sex-specific prevalence and co-occurrence patterns of T2DM and NAFLD among CRC patients and evaluated associated metabolic profiles using electronic medical records (EMRs).

METHODS: We conducted a retrospective EMR-based series study involving 438 CRC patients treated at a tertiary hospital in China, all of whom met strict inclusion criteria, including a complete diagnostic history and colonoscopy between January 2020 and December 2024. Diagnoses of T2DM and NAFLD were confirmed based on explicit physician-documented records. Descriptive statistics and bivariate analyses (chi-square/Fisher's exact and appropriate parametric or non-parametric tests) were used to evaluate prevalence patterns and metabolic indicators.

RESULTS: T2DM and NAFLD were more prevalent in male CRC patients (10.04 and 8.18%, respectively) than in females (5.92 and 4.73%). However, the co-occurrence of both conditions was rare (0.68%). Patients with T2DM or NAFLD showed distinctive metabolic abnormalities, including elevated blood sugar, liver enzymes, and altered lipid profiles. Bivariate analysis identified AST as a potential differentiating marker for NAFLD. Because co-occurrence was rare (3/438, 0.68%), exact analysis showed no evidence of a sex difference in co-occurrence (male vs. female OR = 1.26, 95% CI 0.11-13.99; p = 1.00).

CONCLUSION: This study highlights distinct sex-based prevalence patterns of T2DM and NAFLD in CRC patients; however, co-occurrence was rare, limiting inferential analyses. These findings emphasize the need for larger, prospective studies with refined ascertainment to better characterize metabolic comorbidity patterns in CRC, particularly from a sex-specific perspective.