It is important to monitor patients with nonalcoholic steatohepatitis (NASH), because this group has an elevated risk of developing HCC even without cirrhosis (LoE 2b) (10). The recent sharp rise in the number of patients with metabolic syndrome and diabetes mellitus and the associated obesity has already led to an increase in the incidence of HCC. The annual incidence of HCC in NASH patients is estimated at 2.6% (10). Treatment with metformin can reduce the risk of HCC in this group (LoE 3b), as shown by several retrospective and also prospective cohort studies (11, 12). Owing to the synergistic effects of various liver noxae in the genesis of HCC, the DGVS recommends abstention from alcohol, because alcohol consumption can lead to cirrhosis during the course of any kind of liver disease and accelerate the development of HCC (6).