Investigating the Relationship Between Fatty Liver Disease and Prostate Cancer in U.S. Adults: A Population-Based Study

Introduction Prostate cancer remains one of the most commonly diagnosed cancers in men globally, while non-alcoholic fatty liver disease (NAFLD) has emerged as a leading chronic liver condition, affecting approximately one-quarter of the world’s population. Given the overlap in metabolic risk factors and shared pathways such as chronic inflammation and hormonal dysregulation, there is growing interest in understanding whether NAFLD contributes to prostate cancer risk. This study aimed to evaluate whether men with a history of NAFLD have increased odds of reporting prostate cancer in a nationally representative U.S. sample. Methods Data were drawn from the 2021–2023 cycles of the National Health and Nutrition Examination Survey (NHANES). Adult male participants with available data on liver health, cancer history, and demographic characteristics were included. Prostate cancer and NAFLD status were determined through self-reported diagnoses. Logistic regression was used to assess the association between NAFLD and prostate cancer, adjusting for age, race/ethnicity, education, and marital status. Results Among 11,900 participants, 227 (1.9%) reported a diagnosis of fatty liver and 5,558 were male. Prostate cancer was not significantly associated with NAFLD after adjusting for covariates (OR = 0.83, 95% CI: 0.24–2.82, p = 0.774). However, older age was strongly associated with increased prostate cancer risk (OR = 1.10 per year, p < 0.001). Being not married was associated with lower odds of prostate cancer (OR = 0.52, p = 0.002), and White participants had significantly lower odds than Black participants (OR = 0.33, p = 0.001). Conclusion This analysis did not identify a significant association between NAFLD and prostate cancer, aligning with prior studies showing inconclusive or null results. Despite biological plausibility through mechanisms such as insulin resistance and systemic inflammation, NAFLD’s role in prostate carcinogenesis remains uncertain. In contrast to more established associations between NAFLD and colorectal cancer, the link to prostate cancer appears weaker or more complex. Future research using biopsy-confirmed liver disease and prospective data may clarify these relationships.