Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma

Abstract

The prevalence of hepatocellular carcinoma (HCC) is increasing worldwide, whereas that of most other cancers is decreasing. Non-alcoholic fatty liver disease (NAFLD), which has increased with the epidemics of obesity and type 2 diabetes, increases the risk of HCC. Interestingly, NAFLD-associated HCC can develop in patients with or without cirrhosis. A lack of awareness about NAFLD-related HCC has led to delays in diagnosis. Therefore, a large number of patients with HCC are diagnosed with advanced-stage HCC with low 5-year survival. In this context, increasing awareness of NAFLD and NAFLD-related HCC may lead to earlier diagnosis and more effective interventions.

Keywords: ALD, alcohol-related liver disease; CVD, cardiovascular disease; ELF, enhanced liver fibrosis; FIB-4, fibrosis-4; HCC, hepatocellular carcinoma; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; PDGF, platelet-derived growth factor; STAT3, signal transducer and activator of transcription 3; TNF, tumour necrosis factor-α; VEGF, vascular endothelial growth factor; awareness; cirrhosis; natural history; non-cirrhosis; surveillance.

Fig. 1

Diagram of the pathophysiology of NAFLD-related hepatocellular carcinoma. NAFLD, non-alcoholic fatty liver disease. Figure reproduced with permission from DeGruyer publishing. The figure is from Lequoy M, Gigante E, Couty JP, Desbois-Mouthon C. Hepatocellular carcinoma in the context of non-alcoholic steatohepatitis (NASH): recent advances in the pathogenic mechanisms. Horm Mol Biol Clin Investig. 2020 Feb 29;41(1):/j/hmbci.2020.41.issue-1/hmbci-2019-0044/hmbci-2019-0044.xml. doi: 10.1515/hmbci-2019-0044. PMID: 32112699.