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Balsano et al. Hepatoma Research 2018;4:38 Hepatoma Research
DOI: 10.20517/2394-5079.2018.51

Review Open Access

Fat and hepatocellular carcinoma

1,2
1,2
1,2
Clara Balsano , Cristiana Porcu , Silvia Sideri , Simona Tavolaro 1,2
1 MESVA Department, University of L’Aquila, L’Aquila 67100, Italy.
2 Francesco Balsano Foundation, Rome 00198, Italy.
Correspondence to: Prof. Clara Balsano, MESVA Department, University of L’Aquila, L’Aquila 67100, Italy.
E-mail: clara.balsano@cc.univaq.it

How to cite this article: Balsano C, Porcu C, Sideri S, Tavolaro S. Fat and hepatocellular carcinoma. Hepatoma Res 2018;4:38.
http://dx.doi.org/10.20517/2394-5079.2018.51

Received: 28 May 2018 First Decision: 25 Jun 2018 Revised: 7 Jul 2018 Accepted: 8 Jul 2018 Published: 25 Jul 2018
Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Obesity and diabetes are associated with the onset of hepatocellular carcinoma (HCC). These two illnesses
correlate also with the development of non-alcoholic fatty liver disease (NAFLD). Currently, NAFL is considered
the leading form of chronic liver disease in the Western industrialized countries. Insulin resistance is the common
pathogenic factor among these three pathologies. NAFL is characterized by fat accumulation in the liver that
involves greater than 5% of the liver parenchyma with no evidence of hepatocyte injury. However, NAFL may
progress toward non-alcoholic steatohepatitis that in turn may lead to advanced fibrosis, cirrhosis and HCC. It
is alarming that NAFLD related HCC has been, at present, considered as a growing burden worldwide, and its
prevalence is tending to further increase together with the increasing incidence of obesity and diabetes. Worthy of
note is that in the presence of chronic accumulation of fat in the liver it has been reported the emergence of HCC
during chronic liver disease in absence of liver cirrhosis, usually the major risk factor for the development of HCC.
Thus, in the future NAFLD related HCCs will place a growing strain on health-care systems from the need for their
management. Unfortunately, most of the NAFLD related HCC patients are diagnosed at advanced stages and are
characterized by a poor prognosis, because they are ineligible to radical treatments. Thus, it is urgent to boost up
new screening policies to make early diagnoses, as well as to develop preventive-therapeutic strategies.

Keywords: Hepatocellular carcinoma, obesity, non-alcoholic fatty liver, non-alcoholic steatohepatitis, copper

INTRODUCTION
In Western countries the growing epidemics of obesity and type 2 diabetes are associated with increasing
[1]
incidence of hepatocellular carcinoma (HCC) . These two conditions are strictly associated with the de-
velopment of non-alcoholic fatty liver disease (NAFLD) and considered the leading forms of chronic liver

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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