{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:03:13Z","timestamp":1779771793854,"version":"3.53.1"},"reference-count":52,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Hepatocellular carcinoma (HCC) incidence in Texas is 45% higher than the national average, with disproportionate burden among the Hispanic\/Latino population. Despite significant health disparities, comprehensive evidence on HCC risk factors specific to this population remains limited. This scoping review of 20 primarily observational studies utilized PubMed, EbscoHost, and the PRISMA-ScR checklist to map risk factors in south Texas. Results show that metabolic dysfunction, specifically diabetes and obesity, increases advanced liver disease odds by 7- to 12-fold compared to non-Hispanic groups. Environmental exposures are also significant: aflatoxin was detected in 5.7 to 7.3% of Hispanic\/Latino HCC tumors, and cases demonstrated 6-fold higher odds of aflatoxin biomarkers, while alcohol contributed to 3.0% of cancers. Furthermore, PNPLA3 genetic variants exerted synergistic effects with obesity and heavy alcohol consumption. Among four intervention studies, strategies included low-dose calcium montmorillonite clay for aflatoxin reduction, community-health-worker-integrated chronic care, and hospital-based hepatitis screening. However, critical research gaps remain regarding multirisk factor interactions, toxin dose\u2013response characterization, dietary interventions, and longitudinal data. These findings underscore the urgent need for culturally tailored, community-engaged prevention programs and ethnicity-specific HCC guidelines for the Texas Hispanic\/Latino population to effectively address these rising health disparities.<\/jats:p>","DOI":"10.3390\/ijms27104648","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:53:24Z","timestamp":1779371604000},"page":"4648","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Hepatocellular Carcinoma in Latino Populations in Texas: A Scoping Review"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0089-6978","authenticated-orcid":false,"given":"Lais Yuki","family":"Tuzino Kamia","sequence":"first","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra M.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Gomez","sequence":"additional","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariann M.","family":"Canales","sequence":"additional","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6018-9528","authenticated-orcid":false,"given":"Ramona Salcedo","family":"Price","sequence":"additional","affiliation":[{"name":"Nutrition and Foods Program, School of Family and Consumer Sciences, College of Applied Arts, Texas State University, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","article-title":"Hepatocellular carcinoma","volume":"7","author":"Llovet","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"ref_3","unstructured":"(2026, January 12). USCS Data Visualizations, Available online: https:\/\/statecancerprofiles.cancer.gov\/incidencerates\/index.php?statefips=48&areatype=county&cancer=035&race=00&sex=0&age=001&ruralurban=0&type=incd#results."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1002\/hep.31811","article-title":"State-Level HCC Incidence and Association with Obesity and Physical Activity in the United States","volume":"74","author":"Lee","year":"2021","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1093\/jnci\/djae207","article-title":"Integrative multi-omics characterization of hepatocellular carcinoma in Hispanic patients","volume":"116","author":"Das","year":"2024","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1007\/s10620-020-06231-4","article-title":"Texas Has the Highest Hepatocellular Carcinoma Incidence Rates in the USA","volume":"66","author":"Sardell","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1158\/1940-6207.CAPR-17-0235","article-title":"Prevalence of Aflatoxin-Associated TP53R249S Mutation in Hepatocellular Carcinoma in Hispanics in South Texas","volume":"11","author":"Jiao","year":"2018","journal-title":"Cancer Prev. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sokale, I.O., Rosales, O., Thrift, A.P., El-Serag, H.B., Burgess, E., and Oluyomi, A.O. (2025). Differences in Hepatocellular Carcinoma Incidence Trends Across US Census Divisions, 2001 to 2021. Cancers, 17.","DOI":"10.3390\/cancers17091431"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.21037\/jgo-23-25","article-title":"Time-trends in liver cancer incidence and mortality rates in the U.S. from 1975 to 2017: A study based on the Surveillance, Epidemiology, and End Results database","volume":"14","author":"Yao","year":"2023","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma","volume":"69","author":"Galle","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1016\/j.cgh.2015.08.014","article-title":"Hepatocellular Carcinoma from Epidemiology to Prevention: Translating Knowledge into Practice","volume":"13","author":"Singal","year":"2015","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11894-019-0681-x","article-title":"The Epidemiology of Hepatocellular Carcinoma in the USA","volume":"21","author":"Kim","year":"2019","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4103","DOI":"10.3748\/wjg.v21.i14.4103","article-title":"Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: An open question","volume":"21","author":"Streba","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/j.jhep.2021.07.025","article-title":"Prevention of NAFLD-associated HCC: Role of lifestyle and chemoprevention","volume":"75","author":"Lange","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1038\/ajg.2013.476","article-title":"The Effect of PNPLA3 on Fibrosis Progression and Development of Hepatocellular Carcinoma: A Meta-analysis","volume":"109","author":"Singal","year":"2014","journal-title":"Am. J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1016\/j.cgh.2018.11.059","article-title":"Significant Increase in Risk of Fibrosis or Cirrhosis at Time of HCV Diagnosis for Hispanics with Diabetes and Obesity Compared with Other Ethnic Groups","volume":"17","author":"Turner","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"George, E.S., Sood, S., Broughton, A., Cogan, G., Hickey, M., Chan, W.S., Sudan, S., and Nicoll, A.J. (2021). The Association between Diet and Hepatocellular Carcinoma: A Systematic Review. Nutrients, 13.","DOI":"10.3390\/nu13010172"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1038\/ng.3252","article-title":"Exome sequencing of hepatocellular carcinomas identifies new mutational signatures and potential therapeutic targets","volume":"47","author":"Schulze","year":"2015","journal-title":"Nat. Genet."},{"key":"ref_19","first-page":"97","article-title":"Obesity linking to hepatocellular carcinoma: A global view","volume":"1869","author":"Gan","year":"2018","journal-title":"Biochim. Biophys. Acta BBA-Rev. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1146\/annurev-med-090514-013832","article-title":"Liver Cancer: Connections with Obesity, Fatty Liver, and Cirrhosis","volume":"67","author":"Marengo","year":"2016","journal-title":"Annu. Rev. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhang, C., Liu, S., and Yang, M. (2021). Hepatocellular Carcinoma and Obesity, Type 2 Diabetes Mellitus, Cardiovascular Disease: Causing Factors, Molecular Links, and Treatment Options. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.808526"},{"key":"ref_22","first-page":"e36079","article-title":"Does Type 2 Diabetes Increase the Risk of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease Patients: A Systematic Review","volume":"15","author":"Venugopal","year":"2023","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/MCG.0b013e3182a030c4","article-title":"The Association Between Metabolic Syndrome and Hepatocellular Carcinoma: Systemic Review and Meta-analysis","volume":"48","author":"Jinjuvadia","year":"2014","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4254\/wjh.v9.i3.119","article-title":"Dietary factors can protect against liver cancer development","volume":"9","author":"Koumbi","year":"2017","journal-title":"World J. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"15943","DOI":"10.3748\/wjg.v20.i43.15943","article-title":"Alcohol and hepatocellular carcinoma: A review and a point of view","volume":"20","author":"Testino","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jhep.2018.10.008","article-title":"Hepatocellular carcinoma in the setting of alcohol-related liver disease","volume":"70","author":"Nahon","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cai, P., Zheng, H., She, J., Feng, N., Zou, H., Gu, J., Yuan, Y., Liu, X., Liu, Z., and Bian, J. (2020). Molecular Mechanism of Aflatoxin-Induced Hepatocellular Carcinoma Derived from a Bioinformatics Analysis. Toxins, 12.","DOI":"10.3390\/toxins12030203"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/mc.22057","article-title":"Genetic variation in the PNPLA3 gene and hepatocellular carcinoma in USA: Risk and prognosis prediction","volume":"52","author":"Hassan","year":"2013","journal-title":"Mol. Carcinog."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Campani, C., Zucman-Rossi, J., and Nault, J.-C. (2023). Genetics of Hepatocellular Carcinoma: From Tumor to Circulating DNA. Cancers, 15.","DOI":"10.3390\/cancers15030817"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1053\/j.gastro.2023.01.033","article-title":"Global Epidemiology and Genetics of Hepatocellular Carcinoma","volume":"164","author":"Toh","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/JHC.S477141","article-title":"Risk and Prognosis of Hepatocellular Carcinoma in Mexican Americans with Type 2 Diabetes Mellitus","volume":"12","author":"Hatia","year":"2025","journal-title":"J. Hepatocell. Carcinoma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40615-015-0104-0","article-title":"Liver and Other Gastrointestinal Cancers Are Frequent in Mexican Americans","volume":"3","author":"Garza","year":"2016","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Jiao, J., Watt, G.P., Lee, M., Rahbar, M.H., Vatcheva, K.P., Pan, J.-J., McCormick, J.B., Fisher-Hoch, S.P., Fallon, M.B., and Beretta, L. (2016). Cirrhosis and Advanced Fibrosis in Hispanics in Texas: The Dominant Contribution of Central Obesity. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0150978"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.alcohol.2019.10.001","article-title":"Preventable causes of cancer in Texas by race\/ethnicity: Alcohol consumption","volume":"85","author":"Gudenkauf","year":"2020","journal-title":"Alcohol"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1016\/j.cgh.2024.04.006","article-title":"PNPLA3, Obesity, and Heavy Alcohol Use in Cirrhosis Patients May Exert a Synergistic Increase Hepatocellular Carcinoma Risk","volume":"22","author":"Thrift","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1053\/j.gastro.2016.10.042","article-title":"Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma","volume":"152","author":"Singal","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.amjcard.2017.03.010","article-title":"Frequency of Nonalcoholic Fatty Liver Disease and Subclinical Atherosclerosis Among Young Mexican Americans","volume":"119","author":"Gill","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"107975","DOI":"10.1016\/j.ypmed.2024.107975","article-title":"An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas","volume":"184","author":"Lopez","year":"2024","journal-title":"Prev. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1177\/00333549161310S212","article-title":"Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation","volume":"131","author":"Taylor","year":"2016","journal-title":"Public Health Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Jiao, J., Sanchez, J.I., Thompson, E.J., Mao, X., McCormick, J.B., Fisher-Hoch, S.P., Futreal, P.A., Zhang, J., and Beretta, L. (2021). Somatic Mutations in Circulating Cell-Free DNA and Risk for Hepatocellular Carcinoma in Hispanics. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22147411"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/19440049.2016.1198498","article-title":"Intervention trial with calcium montmorillonite clay in a south Texas population exposed to aflatoxin","volume":"28","author":"Pollock","year":"2016","journal-title":"Food Addit. Contam. Part A"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Strnad, P. (2023). Risk stratification for hepatocellular cancer among patients with cirrhosis using a hepatic fat polygenic risk score. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0282309"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/apt.17384","article-title":"Prevalence and factors associated with liver fibrosis among first-degree relatives of Mexican Americans with hepatocellular carcinoma","volume":"57","author":"Sharpton","year":"2023","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.cgh.2017.03.022","article-title":"Lifestyle and Clinical Correlates of Hepatocellular Carcinoma in South Texas: A Matched Case-control Study","volume":"15","author":"Ramirez","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ma, Y., Qiu, C., Wang, B., Zhang, X., Wang, X., Aguilera, R.J., and Zhang, J.-Y. (2022). Autoantibody against Tumor-Associated Antigens as Diagnostic Biomarkers in Hispanic Patients with Hepatocellular Carcinoma. Cells, 11.","DOI":"10.3390\/cells11203227"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.2337\/dc13-2505","article-title":"Prevalence of Metabolic Syndrome Among Hispanics\/Latinos of Diverse Background: The Hispanic Community Health Study\/Study of Latinos","volume":"37","author":"Heiss","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Tadokoro, T., Oura, K., Nakahara, M., Fujita, K., Tani, J., Morishita, A., and Kobara, H. (2025). Genetic Polymorphisms of ALDH2 and ADH1B in Alcohol-Induced Liver Injury: Molecular Mechanisms of Inflammation and Disease Progression in East Asian Populations. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26178328"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.cgh.2018.05.039","article-title":"Racial and Ethnic Differences in Presentation and Outcomes of Hepatocellular Carcinoma","volume":"17","author":"Rich","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Frankova, S. (2024). Trends in hepatocellular carcinoma and viral hepatitis treatment in older Americans. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0307746"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.cgh.2024.06.038","article-title":"Disparities for Hispanic Adults with Metabolic Dysfunction-associated Steatotic Liver Disease in the United States: A Systematic Review and Meta-analysis","volume":"23","author":"Tesfai","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.cgh.2023.08.016","article-title":"Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity","volume":"22","author":"Pinheiro","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4648\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:21:37Z","timestamp":1779769297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijms27104648"],"URL":"https:\/\/doi.org\/10.3390\/ijms27104648","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}