Sex-specific co-occurrence patterns of type 2 diabetes mellitus and nonalcoholic fatty liver disease among patients with colorectal cancer: A retrospective EMR-based series

Mohammadreza Akbarian Khorasgani¹Pouriya Katouzi¹Melika Khalifeh Hadi¹Yunqing Zeng¹Jiaoyang Lu^1*Yasaman Kianpourhafshejani²Masoumeh Amarloei²

• ¹Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
• ²School of Medicine, Shandong University, Jinan, China

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.