Surveillance in high risk patients with NAFLD key to preventing, delaying HCC

WASHINGTON — Increasing rates of obesity and type 2 diabetes in patients has been associated with a high risk for hepatocellular carcinoma following the development of non-alcoholic fatty liver disease, according to a presenter at Emerging Trends in Non-Alcoholic Fatty Liver Disease.

“Talking about the burden of hepatocellular carcinoma in NAFLD, indeed we do not know completely the prevalence or the incidence of hepatocellular carcinoma in NAFLD,” Elisabetta Bugianesi, MD, PhD, of the department of medical sciences at the University of Torino, Italy, said. “Who can have an increased risk of HCC in NAFLD? Mainly white patients, male, obese, significantly older, patients with increased prevalence of diabetes and patients with cardiovascular comorbidities.”

Bugianesi reviewed several studies that analyzed the association of the metabolic syndrome, particularly obesity and type 2 diabetes, and the frequency of HCC in patients with NAFLD. Results indicated that the prevalence and incidence of HCC in patients with NAFLD has increased in line with the increased rates of obesity and type 2 diabetes in patients.

One of the most worrisome problems, according to Bugianesi, is the increasing rates of obesity in children. According to one study of a preschool cohort, the prevalence of childhood obesity was significantly associated with the development of HCC 30 years later.

Another problem Bugianesi reported is that patients with HCC and NAFLD have poorer outcomes compared with patients with HBV and HCV, mainly because poor surveillance is a constant problem for NAFLD. Bugianesi stated that three out of five guidelines on the management of NAFLD support the practice of oncologic follow-up on an individual basis, particularly for patients with obesity and type 2 diabetes. However, she reports that there is no current recommendation to be made on the timing of surveillance in relation to cost effectiveness.

“What could we do to prevent the development of HCC?” Bugianesi said. “Although there are no recognized controlled trials investigating the factors of lifestyle intervention in HCC, we can follow the American Cancer Society guidelines on cancer prevention, which basically says we should achieve and maintain a healthy weight, increase blood-based food, decrease salt, decrease red meat ... and avoid excessive alcohol intake.” – by Talitha Bennett

Reference:

Bugianesi E. Will the Epidemic of NAFLD Be Responsible for the Future Burden of HCC? Presented at: Emerging Trends in Non-Alcoholic Fatty Liver Disease; March 18-19, 2017; Washington.

Disclosure: Bugianesi reports she is an advisor for IBSA and Boehringer.