the proportion of hcc related to obesity diabetes and metabolic syndrome will likely increase in the future nonalcoholic steatohepatitis hcc

Abstract NAFLD is a wide spectrum disease ranging from simple steatosis, NASH to liver cirrhosis and is the most common type of CLD in the Western world (25% in the general population). Many studies showed an increased incidence of T2 DM in patients with NAFLD independently of ordinary risk factors. This association carries more burdens to CVD, also cancer including HCC, which happens particularly in those with NASH and exacerbated by metabolic syndrome. The pathophysiology of NAFLD involves many factors, and the intestinal microbiota plays an important role in the pathogenesis of both NAFLD and HCC. Although the risk ratios of DM, obesity, and metabolic syndrome do not approach those of HCV or HBV, they are far more prevalent conditions than HCV and HBV in developed countries. Given the increasing prevalence of these conditions, the proportion of HCC related to obesity, DM, and metabolic syndrome will likely increase in the future. Lack of a general consensus due to the paucity of data makes us still do not know if it is Possible to Stop or Cease the NASH to Turn into HCC and increase its incidence. However, Exercise, especially vigorous, Metformin and Statins may be helpful. Obeticholic acid, Elafibranor, Selonsertib and Cenicriviroc, the new drugs for NAFLD/NASH treatment we are waiting for, may carry more hope to decrease HCC. Abbreviations: CLD: Chronic Liver Disease; NAFLD: Nonalcoholic Fatty Liver Disease- MS: Metabolic Syndrome; T2DM: Type 2 Diabetes Mellitus; NASH: Non Alcoholic Steatohepatitis; HCC: Hepatocellular Cancer; TLR: Toll-Like Receptor .