Asian perspective on NAFLD-associated HCC.

Area of Science:

• Hepatology and Gastroenterology
• Public Health
• Genetics and Epidemiology

Background:

• Non-alcoholic fatty liver disease (NAFLD) prevalence is 34% in Asia, driving a rise in associated hepatocellular carcinoma (HCC).
• Traditional HCC risk factors persist, but the PNPLA3 gene polymorphism is notably prevalent in East Asia.
• NAFLD in non-obese individuals and challenges in HCC surveillance for undiagnosed cases are significant concerns.

Purpose of the Study:

• To review the evolving epidemiology of HCC in Asia over the last 30 years.
• To highlight the impact of NAFLD and genetic factors on HCC development.
• To discuss the implications for HCC surveillance and prevention strategies.

Main Methods:

• Literature review of epidemiological data on HCC in Asia.
• Analysis of risk factors including traditional, genetic (PNPLA3), and metabolic factors.
• Examination of NAFLD prevalence and its association with HCC, including in non-obese populations.

Main Results:

• HCC epidemiology in Asia has changed, with increasing NAFLD-related cases.
• PNPLA3 polymorphism and metabolic factors contribute to HCC risk, particularly in East Asia.
• Delayed diagnosis due to poor surveillance leads to advanced-stage HCC, limiting treatment options.

Conclusions:

• NAFLD is a critical driver of HCC in Asia, necessitating improved surveillance.
• Understanding genetic and metabolic risk factors is key for targeted HCC prevention.
• Future research should focus on metabolic treatments for HCC prevention in patients with hepatic steatosis and other liver diseases.