Nutrition and metabolism in hepatocellular carcinoma

Hepatocellular carcinoma is the fifth most common human cancer worldwide, with an overall5-year survival in the range of 10%. In addition to the very substantial role of chronic viral hepatitis incausing hepatocellular carcinoma, nutritional status and specific nutritional factors appear to influencedisease risk. This is apparent in the increased risk associated with non-alcoholic hepatic cirrhosis occurringin the context of obesity, the metabolic syndrome, and type 2 diabetes. Specific nutrients and ingested toxins,including ethanol, aflatoxin, microcystins, iron, and possibly components of red meat, also are associatedwith increased hepatocellular carcinoma risk. Other dietary components, including omega-3 fatty acids andbranched chain amino acids, may have protective effects. Recent data further suggest that several metabolicregulatory drugs, including metformin, pioglitazone, and statins, may have the potential to decrease therisk of hepatocellular carcinoma. The available data on these nutritional and metabolic factors in causinghepatocellular carcinoma are reviewed with the goal of identifying the strength of current knowledge anddirections for future investigation.