Epidemiology of hepatocellular carcinoma in metabolic liver disease

Nonalcoholic fatty liver disease and its evolutive form nonalcoholic steatohepatitis (NASH) are nowadays the second/third cause of chronic liver disease worldwide, and their prevalence and incidence are rapidly increasing in parallel to the burden of diabetes and obesity. Hepatocellular carcinoma (HCC) due to NASH (HCC-NASH) has become the major cause of HCC and is now one of the major indications for liver transplant in Western countries, after that due to HCV infection. NASH occurs both in the presence and absence of liver cirrhosis. In this review, we describe the epidemiology of HCC related to metabolic liver disease: not only NASH-HCC but also type 2 diabetes mellitus and obesity-related HCC. Some new practical guidelines for screening and surveillance of patients with metabolic diseases at risk for HCC are also discussed