Se­vere fatty liver dis­ease boosts risk for liver can­cer

The Borneo Post - Nature and health - - Alert - By Ankur Banerjee

PEO­PLE with ad­vanced cases of non-al­co­holic fatty liver dis­ease (NAFLD) may need to be watched for liver can­cer, a large U.S. study sug­gests. Fatty liver dis­ease is known to be linked with a higher risk of a dan­ger­ous liver can­cer called hep­a­to­cel­lu­lar car­ci­noma, or HCC. But doc­tors haven’t known whether some pa­tients are more at risk than oth­ers. The new study showed that when NAFLD pro­gresses to where pa­tients have liver scar­ring, or cir­rho­sis, their risk for HCC is dra­mat­i­cally higher.

NAFLD is the lead­ing cause of chronic liver dis­ease in the US, af­fect­ing ap­prox­i­mately 30 per cent of the adult pop­u­la­tion. Of­ten associated with obe­sity and di­a­betes, it in­volves a build-up of fat in the liver not caused by drink­ing al­co­hol. The find­ings sug­gest that peo­ple with NAFLD and cir­rho­sis should be mon­i­tored for HCC, the authors write in the jour­nal Gas­troen­terol­ogy. Among peo­ple with less se­vere NAFLD, the risk of liver can­cer was not par­tic­u­larly high. There­fore, the need for reg­u­lar mon­i­tor­ing doesn’t ap­ply to ev­ery­one with NAFLD, Dr Talal Ad­hami told Reuters Health in a phone in­ter­view. Ad­hami, a mem­ber of the Amer­i­can Liver Foun­da­tion’s Na­tional Med­i­cal Ad­vi­sory Com­mit­tee, was not in­volved in the study. In fact, most peo­ple with NAFLD never de­velop cir­rho­sis. In one ear­lier study, for ex­am­ple, only five per cent of peo­ple with NAFLD de­vel­oped liver scar­ring dur­ing roughly eight years of fol­low-up.

The re­searchers an­a­lysed Vet­er­ans Health Ad­min­is­tra­tion data on nearly 300,000 peo­ple with NAFLD and a sim­i­lar num­ber of peo­ple with healthy liv­ers who were tracked for an av­er­age of 11 years. Over the course of a year, roughly one case of liver can­cer was di­ag­nosed in ev­ery 50,000 pa­tients with healthy liv­ers. Not sur­pris­ingly, the rate was higher among peo­ple with NAFLD: one case of can­cer for ev­ery 5,000 peo­ple. But for pa­tients with NAFLD and cir­rho­sis, the risk was markedly higher. Over the course of a year, re­searchers di­ag­nosed more than 50 cases for ev­ery 5,000 pa­tients with ad­vanced liver dis­ease. The study also found higher rates of HCC in men and older pa­tients, and lower rates in women and pa­tients un­der age 45. The risk was high­est in older His­panic peo­ple and rel­a­tively low in African-Amer­i­can adults. Study leader Dr Fasiha Kan­wal, of Bay­lor Col­lege of Medicine and Michael E. DeBakey Vet­er­ans Af­fairs Med­i­cal Cen­tre in Hous­ton, Texas, said in a state­ment the study was the first large, di­verse co­hort study to quan­tify the risk of HCC in pa­tients with NAFLD. “This study gives an idea of whom you need to put on your radar for screen­ing and which other pa­tients have less risk of de­vel­op­ing HCC,” Ad­hami said. The Amer­i­can Liver Foun­da­tion notes on its web­site that there are no treat­ments yet for NAFLD. “Eat­ing a healthy diet and ex­er­cis­ing reg­u­larly may help pre­vent liver dam­age from start­ing or re­verse it in the early stages,” the group says. Peo­ple with NAFLD should also see a doc­tor who spe­cialises in the liver; lose weight, if they are over­weight or obese; lower their choles­terol and triglyc­erides; con­trol their blood su­gar lev­els; and avoid al­co­hol.

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