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Intermittent fasting has the potential to beneficially act upon several pathways that are involved in hepato-cellular carcinoma pathogenesis. Especially among non-alcoholic steatohepatitis patients (NASH), intermittent fasting could effectively reduce the chance of progression to advanced liver disease and hepatocellular carcinoma. Although intermittent fasting activates similar pathways among those without NASH, the altered metabolism in cirrhotic patients may make them exceptionally vulnerable to malnutrition and increase the risk of liver-related adverse events.

Hepatocellular carcinoma (HCC), one of the leading causes of cancer-related deaths worldwide, is a multistep process that usually develops in the background of cirrhosis, but also in a non-cirrhotic state in patients with non-alcoholic fatty liver disease (NAFLD) or viral hepatis. Emerging evidence suggests that intermittent fasting can reduce the risk of cancer development and could improve response and tolerance to treatment through the metabolic and hormonal adaptations induced by the low energy availability that finally impairs cancer cells’ adaptability, survival and growth. The current review will outline the beneficial effects of fasting in NAFLD/NASH patients and the possible mechanisms that can prevent HCC development, including circadian clock re-synchronization, with a special focus on the possibility of applying this dietary intervention to cirrhotic patients.