Non-alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries, and accumulating evidence suggests it as the hepatic manifestation of the metabolic syndrome (MS). Although the published prevalence of hepatocellular carcinoma (HCC) is low in NAFLD/NASH patients, most of these data have been derived from areas endemic for viral hepatitis. We recruited 162 adults with HCC between February 2007 and March 2008, investigated the underlying etiologies and determined the prevalence of the MS and related features within each group. Patients with NAFLD/NASH-associated HCC exhibited a higher prevalence of metabolic features (Type 2 diabetes mellitus, hypertension, dyslipidemia, coronary artery disease) compared to non-NAFLD/NASH-HCC. Intriguingly, a significant number (41.7%; p < 0.005) of individuals with NAFLD/NASH-HCC had no evidence of cirrhosis. Patients with alcohol-induced liver disease also displayed many features (14/19, 73.7%) of the MS, although, in contrast to NAFLD/NASH-HCC, alcohol-associated HCC was highly associated with cirrhosis (95.0%; p = 0.064). NAFLD/NASH as the hepatic entity of the MS may itself pose a risk factor for HCC, even in the absence of cirrhosis. The MS may also promote development of HCC among those with alcoholic liver disease. Increased awareness of liver manifestations in the MS may instigate early interventions against developing HCC.
Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
Judith
J
Ertle
Alexander
A
Dechêne
Jan-Peter
JP
Sowa
Volker
V
Penndorf
Kerstin
K
Herzer
Gernot
G
Kaiser
Jörg F
JF
Schlaak
Guido
G
Gerken
Wing-Kin
WK
Syn
Ali
A
Canbay
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male