The virus seems to directly interfere with insulin signaling, and patients with chronic hepatitis C frequently present with insulin resistance. Ruhl et al. revisit this association and their results actually challenge it. The researchers used the National Health and Nutrition Examination Survey data of more than 15,000 adults to test whether the prevalences of diabetes and prediabetes (American Diabetes Association criteria) were different selleck chemicals llc in HCV-positive, compared to HCV-negative, patients. The prevalences

of diabetes and prediabetes did not differ by HCV status, but they were higher in patients with elevated liver tests. The researchers conclude that elevated liver tests may account for the previously reported associations between HCV and diabetes. (Hepatology 2014;60:1139-1149.) Vitamin D deficiency has been associated with increased risk of several cancers, in particular, colorectal cancer. What about hepatocellular carcinoma (HCC)? Fedirko et al. used the EPIC cohort, which enrolled more than 500,000 Europeans, to build a prospective, nested case-control study around the 138 individuals who developed an HCC. They measured prediagnostic circulating levels of 25-hydroxyvitamin D (on average, 6 years Veliparib cost before HCC

diagnosis). Lower 25-hydroxyvitamin D levels were associated with a 49% increase in the risk of HCC. This association remained after adjustment for several possible confounding factors. Mechanistically, vitamin D has been reported to inhibit hepatic fibrogenesis and

have direct antineoplastic properties. These data suggest that vitamin D supplementation might find more be hepatoprotective. (Hepatology 2014;60:1222-1230.) Surveillance for HCC is essential. Individuals at risk can be identified and have access to curative treatments only at early asymptomatic stages. Alfa-fetoprotein (AFP) is far from perfect, and surveillance relies on biannual sonography. In this context, the work of Ladep et al., from the PROLIFICA consortium, is a welcome opening. They compared the urinary metabolite phenotypes of patients with HCC, cirrhosis without HCC, liver disease without cirrhosis, and healthy volunteers. The investigators were able to identify a rather simple urinary metabolite signature associated with HCC, which outperformed AFP. These findings were duplicated in a validation cohort. This work was conducted with samples collected in West Africa, a region where HCC is particularly prevalent because of hepatitis B virus and exposure to aflatoxin. It will be interesting to find out whether the same signature applies in other geographic regions, where other factors are at play. In any case, such a metabolite-centric approach seems promising. (Hepatology 2014;60:1291-1301.) Given that hepatocytes are resistant to conventional chemotherapeutics, antiangiogenic drugs, which target vascular cells, may prove efficacious.