NAFLD and Hepatocellular Carcinoma: how big a problem is this really?

A definite link between non alcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma (HCC) has emerged. Diabetes, older age and the presence of cirrhosis are the key risk factors for HCC in patients with NAFLD. Although the rates of development of HCC are generally lower compared with viral (HCV) aetiology, the absolute burden of NASH-related HCC is higher. Diagnostic delay, older age and the concurrent presence of severe metabolic or vascular disease limits potentially curative treatment, such as liver transplantation. Most worrisome, is the recent evidence that HCC may develop also in non-cirrhotic livers with NAFLD, particularly in the presence of multiple metabolic risk factors. In the coming decades, we expect a change in the burden of the attributable proportion of HCC shifting from viral hepatitis to NASH, as the major risk factor for HCC worldwide.