Multiple factors have been postulated to explain this difference, including variations in risk factors, sex steroid hormones, adiponectin levels leading to distinct molecular gene and pathways alterations.[35], [36], [37] However, data from the USA, where the obesity prevalence is among the highest worldwide, have shown that the population attributable fraction for metabolic disorders to develop HCC was similar in men and women and type 2 diabetes was associated with an even higher adjusted hazard ratio of developing HCC in women compared with men.38 This evidence concerns the gene ADIPOQ and obesity due to melanocortin 4 receptor deficiency.