Clin Mol Hepatol > Volume 30(3); 2024 > Article
Clinical and Molecular Hepatology 2024;30(3): 436-448.
Global prevalence of metabolic dysfunction-associated fatty liver disease-related hepatocellular carcinoma: A systematic review and meta-analysis
Harry Crane1, Guy D. Eslick2, Cameron Gofton1,3, Anjiya Shaikh4, George Cholankeril5, Mark Cheah6, Jian-Hong Zhong7, Gianluca Svegliati-Baroni8, Alessandro Vitale9, Beom Kyung Kim10, Sang Hoon Ahn10, Mi Na Kim10, Simone I Strasser11, Jacob George1
1Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
2NHMRC Centre for Research Excellence in Digestive Diseases, Hunter Medical Research Institute (HMRI), The University of Newcastle, Newcastle, NSW, Australia
3Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW, Australia
4Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
5Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
6Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
7Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China
8Liver Injury and Transplant Unit, Polytechnic University of Marche, Ancona, Italy
9Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
10Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
11AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, VIC, Australia
Correspondence :  Jacob George ,
Tel: +61-2-8890-7705, Fax: +61-2-96357582, Email:
Received: February 15, 2024  Revised: April 11, 2024   Accepted: April 15, 2024
The global proportion of hepatocellular carcinoma (HCC) attributable to metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. The MAFLD diagnostic criteria allows objective diagnosis in the presence of steatosis plus defined markers of metabolic dysfunction, irrespective of concurrent liver disease. We aimed to determine the total global prevalence of MAFLD in HCC cohorts (total-MAFLD), including the proportion with MAFLD as their sole liver disease (single-MAFLD), and the proportion of those with concurrent liver disease where MAFLD was a contributary factor (mixed-MAFLD).
This systematic review and meta-analysis included studies systematically ascertaining MAFLD in HCC cohorts, defined using international expert panel criteria including ethnicity-specific BMI cut-offs. A comparison of clinical and tumour characteristics was performed between single-MAFLD, mixed-MAFLD, and non-MAFLD HCC.
22 studies (56,565 individuals with HCC) were included. Total and single-MAFLD HCC prevalence was 48.7% (95% confidence interval [CI] 34.5–63.0%) and 12.4% (95% CI 8.3–17.3%), respectively. In HCC due to chronic hepatitis B, C, and alcohol-related liver disease, mixed-MAFLD prevalence was 40.0% (95% CI 30.2–50.3%), 54.1% (95% CI 40.4–67.6%) and 64.3% (95% CI 52.7–75.0%), respectively. Mixed-MAFLD HCC had significantly higher likelihood of cirrhosis and lower likelihood of metastatic spread compared to single-MAFLD HCC, and a higher platelet count and lower likelihood of macrovascular invasion compared to non-MAFLD HCC.
MAFLD is common as a sole aetiology, but more so as a co-factor in mixed-aetiology HCC, supporting the use of positive diagnostic criteria.
KeyWords: Fatty liver; Hepatocellular carcinoma; Epidemiology; Prevalence; Metabolic syndrome

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