Metabolic syndrome, non-alcoholic fatty liver disease and hepatocarcinoma

Abstract

Metabolic syndrome is a group of disorders including central obesity, decreased levels of high-density lipoprotein cholesterol, increased triglyceride concentration, hypertension, and hyperglycemia. This syndrome has become a 21st-century epidemic. Causal agents include insulin resistance, leptin and adiponectin, changes in microbiota, and epigenetics. Incidence is estimated to be around 25% of the European population. Non-alcoholic fatty liver disease is the hepatic manifestation of metabolic syndrome. Its prevalence parallels that of obesity, and has increased exponentially over the last few decades. Recently, several publications have associated metabolic risk factors with the development and progression of hepatocellular carcinoma. In this context establishing whether patients with non-alcoholic fatty liver disease should go through a screening protocol for hepatocellular carcinoma is of the utmost importance.To date, the reported worldwide incidence of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease without cirrhosis is 2.7% at 10 years. Although screening for hepatocellular carcinoma in patients with non-alcoholic fatty liver disease and cirrhosis is mandatory, the low incidence of hepatocellular carcinoma in patients without cirrhosis does not justify a systematic surveillance of this population. Efforts are made to determine which subgroups of patients with non-alcoholic fatty liver disease are at higher risk of developing hepatocellular carcinoma.