The article reviews the changing etiology and epidemiology of hepatocellular carcinoma (HCC) globally, with a focus on Asia. HCC is the most common type of primary liver cancer, accounting for 80-90% of cases, and is a significant health and economic burden, especially in Asia. The incidence and mortality of HCC vary significantly worldwide due to differences in environmental and infectious risk factors, healthcare accessibility, and early detection methods. The main contributors to HCC development are chronic hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection. However, there has been a slow but continuous decline in HBV infection rates since 1990, and the incidence of HCV-related HCC has significantly decreased in Japan and European countries due to the widespread use of direct-acting antivirals. In contrast, the proportion of patients with alcoholic and nonalcoholic steatohepatitis (NASH)-related HCC has increased. NASH-related HCC is characterized by older patients, higher body mass index, and higher rates of type 2 diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disease. The article highlights the increasing prevalence of NAFLD, which is now the most common liver disease globally. In Asia, the prevalence of NAFLD has risen significantly, and it is projected to increase further. NAFLD-associated HCC is more common in the absence of cirrhosis, unlike other etiologies such as alcohol-related and autoimmune liver diseases. The incidence of NAFLD-associated HCC is higher in patients with cirrhosis due to NASH, and it is the second-largest group among patients requiring liver transplantation after those with HCV infection. To address the increasing number of patients with NAFLD-HCC, effective strategies are needed, including controlling NAFLD epidemiology, screening for NAFLD in patients with metabolic diseases, identifying surveillance methods and targets, and optimizing treatment for NAFLD-associated HCC. The article emphasizes the need for collaboration between government and academic societies to manage this growing health challenge.The article reviews the changing etiology and epidemiology of hepatocellular carcinoma (HCC) globally, with a focus on Asia. HCC is the most common type of primary liver cancer, accounting for 80-90% of cases, and is a significant health and economic burden, especially in Asia. The incidence and mortality of HCC vary significantly worldwide due to differences in environmental and infectious risk factors, healthcare accessibility, and early detection methods. The main contributors to HCC development are chronic hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection. However, there has been a slow but continuous decline in HBV infection rates since 1990, and the incidence of HCV-related HCC has significantly decreased in Japan and European countries due to the widespread use of direct-acting antivirals. In contrast, the proportion of patients with alcoholic and nonalcoholic steatohepatitis (NASH)-related HCC has increased. NASH-related HCC is characterized by older patients, higher body mass index, and higher rates of type 2 diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disease. The article highlights the increasing prevalence of NAFLD, which is now the most common liver disease globally. In Asia, the prevalence of NAFLD has risen significantly, and it is projected to increase further. NAFLD-associated HCC is more common in the absence of cirrhosis, unlike other etiologies such as alcohol-related and autoimmune liver diseases. The incidence of NAFLD-associated HCC is higher in patients with cirrhosis due to NASH, and it is the second-largest group among patients requiring liver transplantation after those with HCV infection. To address the increasing number of patients with NAFLD-HCC, effective strategies are needed, including controlling NAFLD epidemiology, screening for NAFLD in patients with metabolic diseases, identifying surveillance methods and targets, and optimizing treatment for NAFLD-associated HCC. The article emphasizes the need for collaboration between government and academic societies to manage this growing health challenge.