Nonalcoholic steatohepatitis and hepatocellular carcinoma: Beyond the boundaries of the liver

Abstract

The burden of non-alcoholic steatohepatitis (NASH) related hepatocellular carcinoma (HCC) is drawing attention due to the emerging epidemic of obesity and metabolic syndrome and is expected to increase in the near future. Antidiabetic medications, air pollutants, and newer genetic mutations are latest concerns as risk factors for HCC development in patients with NASH. Although molecular signatures are very accurate, they are not cost-effective and cannot be applied in larger population due to logistic issues. We need multicentric longitudinal studies including diverse geographical areas to evaluate the complex interplay of different risk factors and genetics in these patients.

Keywords: Non-alcoholic steatohepatitis; Hepatocellular carcinoma; Cirrhosis; Genetic factors; Lifestyle factors; Surveillance

Core Tip: Nonalcoholic steatohepatitis (NASH) is a metabolic liver disease which also involves multiple organs like the heart, lungs, and kidneys. NASH may arise primarily, followed by involvement of other organs, or it may come late in the course of metabolic syndrome. The multidisciplinary approach is needed towards a patient with diabetes, obesity, and metabolic syndrome to address all issues related to the liver, heart, etc. Genetic and molecular signatures have provided a ray of hope for estimating risk in these patients; however, it has many practical issues. The impact of environmental pollutants and toxins as a causative factor in NASH, especially lean patient population, should also be considered. We need population based studies from different geographical areas for estimation of metabolic, environmental, and genetic risk factors.