Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention

By Daniel Q. Huang, H. B. EL‐SERAG, R. Loomba. Nature reviews: Gastroenterology & hepatology, 2020

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One quarter of the global population is estimated to have nonalcoholic fatty liver disease (NAFLD). The incidence of nonalcoholic steatohepatitis (NASH) is projected to increase by up to 56% in the next 10 years. NAFLD is already the fastest growing cause of hepatocellular carcinoma (HCC) in the USA, France and the UK. Globally, the prevalence of NAFLD-related HCC is likely to increase concomitantly with the growing obesity epidemic. The estimated annual incidence of HCC ranges from 0.5% to 2.6% among patients with NASH cirrhosis. The incidence of HCC among patients with non-cirrhotic NAFLD is lower, approximately 0.1 to 1.3 per 1,000 patient-years. Although the incidence of NAFLD-related HCC is lower than that of HCC of other aetiologies such as hepatitis C, more people have NAFLD than other liver diseases. Urgent measures that increase global awareness and tackle the metabolic risk factors are necessary to reduce the impending burden of NAFLD-related HCC. Emerging evidence indicates that reduced immune surveillance, increased gut inflammation and gut dysbiosis are potential key steps in tumorigenesis. In this Review, we discuss the global epidemiology, projections and risk factors for NAFLD-related HCC, and propose preventive strategies to tackle this growing problem. The prevalence of nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is projected to continue to increase worldwide. In this Review, Huang, El-Serag and Loomba discuss the global epidemiology and risk factors for NAFLD-related HCC, and propose strategies to tackle this problem. Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis and nonalcoholic steatohepatitis (NASH); NASH can be progressive and predisposes individuals to the development of fibrosis and cancer. NAFLD-related hepatocellular carcinoma (HCC) can develop in the absence of cirrhosis. NAFLD is the fastest growing cause of HCC in many parts of the world, including the USA and parts of Europe. The incidence of NAFLD-related HCC is projected to increase dramatically by 2030, with increases of 82%, 117% and 122% from 2016 in China, France and the USA, respectively. Diabetes is the most important risk factor for HCC development in patients with NAFLD; thus, screening and early treatment are essential. Dysregulation of the gut microbiota and reduced immune surveillance are two new mechanisms that have been implicated in NAFLD hepatocarcinogenesis, and further research is warranted. Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis and nonalcoholic steatohepatitis (NASH); NASH can be progressive and predisposes individuals to the development of fibrosis and cancer. NAFLD-related hepatocellular carcinoma (HCC) can develop in the absence of cirrhosis. NAFLD is the fastest growing cause of HCC in many parts of the world, including the USA and parts of Europe. The incidence of NAFLD-related HCC is projected to increase dramatically by 2030, with increases of 82%, 117% and 122% from 2016 in China, France and the USA, respectively. Diabetes is the most important risk factor for HCC development in patients with NAFLD; thus, screening and early treatment are essential. Dysregulation of the gut microbiota and reduced immune surveillance are two new mechanisms that have been implicated in NAFLD hepatocarcinogenesis, and further research is warranted.

Subfields: Epidemiology, Hepatology

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