Epidemiology and Etiologic Associations of Non-alcoholic Fatty Liver Disease and Associated HCC.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world and will soon become the number one cause of hepatocellular carcinoma (HCC), liver transplantation and liver-related mortality. The disease often occurs in the setting of metabolic conditions such as obesity and type II diabetes mellitus. These same metabolic drivers are also risk factors for NAFLD associated HCC which can occur even in the absence of cirrhosis or advanced fibrosis and appears to be phenotypically different to HCCs arising from other chronic liver diseases. The frequencies of liver-related events and HCC among NAFLD patients is low, especially when compared to cardiovascular disease and extrahepatic malignancies. However, the large denominator of total patients affected with NAFLD means that these events will impose an enormous clinical and economic burden on our society. Moreover, this burden is expected to rise further in the future. Therefore, the global NAFLD epidemic has arrived at our doorstep and demands our attention.