Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina, Italy.
Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina, Italy; Division of Clinical and Molecular Hepatology, Department of Human Pathology, University of Messina, Italy.
Ann Hepatol. 2019 Nov-Dec;18(6):810-815. doi: 10.1016/j.aohep.2019.07.004. Epub 2019 Aug 20.
Obesity prevalence is rapidly increasing worldwide. It is associated with huge economic and health costs due to its clinical consequences, which includes increased incidence of type 2 diabetes, cardiovascular diseases, and development of different malignancies. In particular, obesity is an independent risk factor for the development of hepatocellular carcinoma (HCC). Indeed, obesity is highly prevalent in patients with non-alcoholic fatty liver disease (NAFLD) that is becoming one of the most frequent causes of liver disease worldwide. NAFLD-related HCC is the most rapidly growing indication for liver transplantation in many countries. The higher mortality rates found in obese HCC patients might be related not only to a worse outcome after HCC treatments, but also to a delayed diagnosis related to a low frequency and a poorer quality of abdominal ultrasonography surveillance that is the test universally used for HCC screening. Given its diffusion, obesity is frequently present in patients with chronic liver diseases related to different etiologies, and in these cases it may increase the HCC risk, acting as an additional co-factor. Indeed, growing evidence demonstrates that a healthy diet and regular physical activity may have an impact in reducing the overall HCC risk. Finally, an impact of obesity in the development of intrahepatic cholangiocarcinoma has been postulated, but more extensive studies are needed to definitively confirm this association.
肥胖症在全球范围内迅速流行。由于其临床后果，包括 2 型糖尿病、心血管疾病和不同恶性肿瘤的发生率增加，肥胖症与巨大的经济和健康成本相关。特别是，肥胖症是肝细胞癌（HCC）发展的独立危险因素。事实上，非酒精性脂肪性肝病（NAFLD）患者中肥胖症的患病率很高，NAFLD 已成为全球最常见的肝病病因之一。在许多国家，NAFLD 相关 HCC 是肝移植中增长最快的指征。肥胖 HCC 患者死亡率较高的原因可能不仅与 HCC 治疗后预后较差有关，还与由于腹部超声检查监测的频率较低和质量较差而导致的诊断延迟有关，腹部超声检查是 HCC 筛查的普遍应用的检查。鉴于肥胖症的广泛流行，其在与不同病因相关的慢性肝病患者中经常存在，在这些情况下，它可能会增加 HCC 风险，作为一个额外的共同危险因素。事实上，越来越多的证据表明，健康的饮食和有规律的体育活动可能会对降低整体 HCC 风险产生影响。最后，有人提出肥胖症可能会导致肝内胆管细胞癌的发展，但需要更广泛的研究来明确证实这种关联。
