S population

S. population CP-868596 mw may be limited. In addition, some of these studies were based on small patient numbers and/or limited duration of follow-up, which may have affected their power. The pathogenesis of NAFLD and the factors promoting the progression to NASH and end-stage

liver disease among patients with metabolic syndrome are complex. Recent research has generated stimulating hypotheses on the roles of oxidative stress and lipotoxicity, cytokine action, and molecular and genetic factors that may promote development and progression of NAFLD.36-39 The frequent co-occurrence of metabolic conditions and their interplay complicates the examination of each individual metabolic factor’s contribution to liver disease and hepatocarcinogenesis. For example, it has been acknowledged that the hyperinsulinemia and insulin resistance that

frequently co-occur with (central) obesity plays a main role in the development of hepatic steatosis through deposition of free fatty acids and their metabolites in liver tissue.6, 37 However, chronic liver disease may also cause hepatic insulin resistance, favoring de novo lipogenesis and progression of hepatic steatosis, as well as the development of metabolic risk factors such as diabetes mellitus, dyslipoproteinemia, and hypertension.6, 37 In addition, factors that cause necroinflammation (e.g., cytokines, oxidative stress) may also promote hepatic steatosis, which further complicates the delineation of cause Erlotinib concentration and effect.6 Over MCE公司 the last couple of years, several cohort, case-control and population-based studies have reported the association of diabetes mellitus, obesity, and risk for both types of liver cancer (HCC, ICC).40, 41 These findings support an individual contribution of metabolic

conditions to the development of NAFLD. Few of these studies, however, investigated the combined effects of all metabolic risk factors as defined by the metabolic syndrome on HCC and ICC risk. Among other HCC and ICC risk factors, HCV infection can cause hepatic steatosis and insulin resistance that is mediated by a genotype-dependent interference of the viral core protein with intracellular insulin signaling.42 Some studies also suggest a synergistic effect of HCV infection, metabolic risk factors, and liver cancer risk.43, 44 In this study, however, no statistically significant interaction was observed between HCV infection and metabolic syndrome (data not shown). Although the size of the current study (3649 HCC cases, 743 ICC cases) is quite large, the study had several limitations, including the reliance on medical claims data. It should be noted, however, that Medicare files capture 100% of the coverage claims for tests, outpatients visits, and hospitalizations for patients age 65 years and older with continuous enrollment in Medicare part A and part B.

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