Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2023; 29(2): 286-309
Published online Jan 14, 2023. doi: 10.3748/wjg.v29.i2.286
Screening and interventions to prevent nonalcoholic fatty liver disease/nonalcoholic steatohepatitis-associated hepatocellular carcinoma
Simona Cernea, Danusia Onișor
Simona Cernea, Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureş 540139, Romania
Simona Cernea, Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş 540136, Romania
Danusia Onișor, Department ME2/Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş 540139, Romania
Danusia Onișor, Gastroenterology Department, Mureș County Clinical Hospital, Târgu Mureș 540072, Romania
Author contributions: Cernea S conceived and designed the review, researched the literature, wrote part of the manuscript, edited, created the figures, and critically revised the manuscript for important intellectual content; Onișor D researched the literature and contributed to the writing of the manuscript and final validation; Both authors approved the final version.
Conflict-of-interest statement: The authors declare having no conflicts of interest regarding this paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Simona Cernea, MD, PhD, Associate Professor, Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gheorghe Marinescu st., Târgu Mureş 540139, Romania. simonacernea@yahoo.com
Received: September 18, 2022
Peer-review started: September 18, 2022
First decision: October 19, 2022
Revised: November 6, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 14, 2023
Abstract

Liver cancer is the sixth most commonly diagnosed cancer worldwide, with hepatocellular carcinoma (HCC) comprising most cases. Besides hepatitis B and C viral infections, heavy alcohol use, and nonalcoholic steatohepatitis (NASH)-associated advanced fibrosis/cirrhosis, several other risk factors for HCC have been identified (i.e. old age, obesity, insulin resistance, type 2 diabetes). These might in fact partially explain the occurrence of HCC in non-cirrhotic patients without viral infection. HCC surveillance through effective screening programs is still an unmet need for many nonalcoholic fatty liver disease (NAFLD) patients, and identification of pre-cirrhotic individuals who progress to HCC represents a substantial challenge in clinical practice at the moment. Patients with NASH-cirrhosis should undergo systematic HCC surveillance, while this might be considered in patients with advanced fibrosis based on individual risk assessment. In this context, interventions that potentially prevent NAFLD/ NASH-associated HCC are needed. This paper provided an overview of evidence related to lifestyle changes (i.e. weight loss, physical exercise, adherence to healthy dietary patterns, intake of certain dietary components, etc.) and pharmacological interventions that might play a protective role by targeting the underlying causative factors and pathogenetic mechanisms. However, well-designed prospective studies specifically dedicated to NAFLD/NASH patients are still needed to clarify the relationship with HCC risk.

Keywords: Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, Hepatocellular carcinoma, Risk stratification, Lifestyle interventions, Prevention

Core Tip: Nonalcoholic fatty liver disease (NAFLD) is a public health problem, especially in developed countries. This condition, depending on certain associated risk factors, can ultimately lead to liver cirrhosis and hepatocellular carcinoma (HCC). Having the necessary tools and knowing the characteristics of patients in whom the disease progresses more quickly, effective monitoring programs can be developed. Primary prevention of NAFLD/nonalcoholic steatohepatitis (NASH)-associated HCC relies on controlling the main modifiable risk factors. Some pharmacological (e.g., metformin, statins, aspirin) and non-pharmacological interventions (weight loss, physical exercise, healthy diet, avoiding heavy drinking and smoking) might have protective effects. Herein, we emphasized the need for continued investigations to find the optimal methods for NAFLD/NASH-associated prevention.