Azuma S, et al. - In this study involving patients with non-alcoholic fatty liver disease (NAFLD) who developed hepatocellular carcinoma (HCC), researchers identified risk factors associated with the development of HCC. A total of 182 patients with NAFLD were enrolled in this study between April 2000 and December 2016, of which only 22 had HCC. Upon multivariate analysis, researchers found that the NAFLD fibrosis score (NFS) and hypertension were independent factors significantly associated with HCC development in 182 patients. They also identified diabetic retinopathy as an independent factor that was significantly related to the development of HCC after NFS adjustment. Overall, the investigators found the risk factors associated with the development of HCC in patients with NAFLD to be diabetic retinopathy and liver fibrosis. Patients with NAFLD and diabetic retinopathy should, therefore, be carefully screened for HCC.