{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:07Z","timestamp":1787027767289,"version":"build-2736575974"},"reference-count":57,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Basic Science Research Program through the National Research Foundation of Korea (NRF) under the Ministry of Education, Republic of Korea","award":["2022R1I1A1A01054327"],"award-info":[{"award-number":["2022R1I1A1A01054327"]}]},{"name":"the Basic Science Research Program through the National Research Foundation of Korea (NRF) under the Ministry of Education, Republic of Korea","award":["RS-2023-00222838"],"award-info":[{"award-number":["RS-2023-00222838"]}]},{"name":"Bio &amp; Medical Technology Development Program of the NRF under the Korean government (MSIT)","award":["2022R1I1A1A01054327"],"award-info":[{"award-number":["2022R1I1A1A01054327"]}]},{"name":"Bio &amp; Medical Technology Development Program of the NRF under the Korean government (MSIT)","award":["RS-2023-00222838"],"award-info":[{"award-number":["RS-2023-00222838"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Given the rising incidence of early-onset endometrial cancer diagnosed before the age of 50 years, this study examined whether non-alcoholic fatty liver disease (NAFLD) served as an independent risk factor for early-onset endometrial cancer, irrespective of obesity status. Methods: This nationwide cohort study included 2,311,949 Korean women aged 20\u201339 years who underwent health screenings from 2009 to 2012. NAFLD severity was classified based on the fatty liver index: none (&lt;30), moderate (30\u201359), and severe (\u226560). Multivariable-adjusted Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) for early-onset endometrial cancer. Results: During a median follow-up of 7.6 years, 1289 women developed early-onset endometrial cancer. The cumulative incidence of early-onset endometrial cancer was significantly higher in women with NAFLD than in those without (log-rank p &lt; 0.001). A dose-dependent association was observed, with increased risk corresponding to greater NAFLD severity (aHR [95% confidence interval (CI)]: moderate NAFLD, 2.38 [1.99\u20132.85]; severe NAFLD, 5.39 [4.44\u20136.53]; p for trend &lt; 0.01). Compared with non-obese women without NAFLD, the aHRs for early-onset endometrial cancer were 2.53 [2.11\u20133.05] in non-obese women with NAFLD, 1.66 [1.10\u20132.52] in obese women without NAFLD, and 4.30 [3.60\u20135.13] in obese women with NAFLD (synergy index = 1.50, p &lt; 0.01). Conclusions: NAFLD was independently associated with increased risk of early-onset endometrial cancer in both non-obese and obese women. Furthermore, young women with both NAFLD and obesity exhibited a synergistically elevated risk. Early identification and management of NAFLD may help mitigate the rapidly growing burden of early-onset endometrial cancer.<\/jats:p>","DOI":"10.3390\/cancers17081322","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T03:59:06Z","timestamp":1744689546000},"page":"1322","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Increased Risk of Early-Onset Endometrial Cancer in Women Aged 20\u201339 Years with Non-Alcoholic Fatty Liver Disease: A Nationwide Cohort Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4358-4208","authenticated-orcid":false,"given":"Joo-Hyun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"},{"name":"Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-9332","authenticated-orcid":false,"given":"Jung Yong","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154, USA"},{"name":"Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"},{"name":"Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonseok","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 03181, Republic of Korea"},{"name":"Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-8329","authenticated-orcid":false,"given":"Jay J.","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. 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