While additional research is necessary on the risk factors of HCC in NAFLD, available evidence already suggests that diabetes, insulin resistance, and obesity likely play an important role in carcinogenesis. The epidemiological association indicates that absence of these conditions is associated with a reduction in HCC risk. What remains less clear is whether treatment will result in a benefit. However, it is reasonable to seek and maximize management of concomitant metabolic conditions in patients with NAFLD with the hope of reducing the risk of progression to HCC.