The role of adiponectin, insulin resistance, and vitamin D as predictors of transformation of fatty liver to hepatocellular carcinoma

Introduction
Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world and is responsible for 5% of all malignant tumors in humans. Most HCC cases are related to chronic hepatitis C virus (HCV) infection, chronic hepatitis B (HBV) infection, and alcohol abuse. Approximately 15–50% of HCC cases were classified as idiopathic, suggesting that other risk factors are responsible for its rising incidence. Recent studies have suggested that nonalcoholic fatty liver disease (NAFLD) can be associated with these ‘idiopathic’ cases.
Aim
The aim of the study was to evaluate the levels of both serum 25(OH)VD and adiponectin, as well as homeostatic model assessment insulin resistance as predictors of transformation of NAFLD to HCC among patients with NAFLD, HCV, HBV positive patients and HCC patients.
Patients and Methods
This is a case–control study which was conducted on 100 patients at the Internal Medicine Department in ElMataryia Teaching Hospital. They were classified into 20 patients with NAFLD, 20 patients with HBV positive, 20 patients with HCV positive, and 20 patients with HCC, in addition to 20 age-matched and sex-matched healthy participants,. Full medical history, clinical examination, and laboratory investigations including complete blood count, alanine transaminase, aspartate transaminase, prothrombin time, international normalized ratio, fasting blood sugar, glycated hemoglobin, homeostatic model assessment insulin resistance, hepatitis B antigen, hepatitis B antibody, serum vitamin D, and serum adiponectin, abdominal ultrasound were done. Statistical analysis using SPSS was done.
Results
The level of adiponectin showed a decrease in NAFLD cases (2 μg/ml), but there was an increase in HBV (18 μg/ml), HCV (10.5 μg/ml), and HCC (13 μg/ml) in comparison to the control group (3.75 μg/ml). Further, the cut-off points for adiponectin to detect HCC in NAFLD was found to be greater than 3.2, with a sensitivity of 100% and specificity of 100%.
Conclusion
Serum adiponectin is an excellent marker to predict the transformation of NAFLD to HCC.