Non-alcoholic fatty liver disease and hepatocellular carcinoma

Abstract

The metabolic syndrome refers to a group of alterations comprising central obesity, reduced high-density lipoprotein cholesterol concentrations, elevated triglyceride concentrations, arterial hypertension, and hyperglycemia. This syndrome has established itself as one of the epidemics of the 21st century. Among its causative agents are insulin resistance, leptin and adiponectin, changes in microbiota, and epigenetics. Its incidence in the European population is estimated to be around 25%. Non-alcoholic fatty liver disease is the hepatic manifestation of metabolic syndrome; its prevalence parallels that of obesity, and it has increased exponentially in recent decades. Recently, several publications have linked metabolic risk factors with the onset and development of hepatocellular carcinoma, and so it is essential to determine whether patients with non-alcoholic fatty liver disease should follow a protocol for hepatocellular carcinoma screening. At present, the worldwide incidence of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease without cirrhosis is only 2.7% at 10 years. Screening for hepatocellular carcinoma in patients with nonalcoholic fatty liver disease and cirrhosis is mandatory, but the low incidence of hepatocellular carcinoma in patients without cirrhosis does not justify the systematic monitoring of this patient population. Current efforts are based on identifying subgroups of patients with non-alcoholic fatty liver disease and a higher-than-average risk of developing hepatocellular carcinoma. We present a review of the literature to determine the relationship between non-alcoholic fatty liver disease, non-alcoholic steatohepatitis and hepatocellular carcinoma to establish a guideline for monitoring this type of patients.