Data presented at today's sessions of
the 43rd Annual Meeting of the European Association for the Study of the
Liver (EASL) further confirm that nonalcoholic fatty liver disease (NAFLD)
and its most severe form, nonalcoholic steatohepatitis (NASH), are
associated with the metabolic syndrome and pose an increased risk of
cardiovascular disease.
NAFLD and NASH are significant health problems that affect millions of
people worldwide, especially in Western countries. NAFLD is a fatty
accumulation in the liver that does not result from excessive use of
alcohol. When this condition progresses, and is associated with
inflammation and liver damage, it is then called NASH, which is thought to
occur in 15% to 25% of cases of NAFLD. NASH is clearly associated with the
risk of developing liver cirrhosis, and its complications, including
hepatocellular carcinoma, the most frequent primary tumour of the liver.
NASH-related cirrhosis is an increasingly occurring indication for liver
transplantation.
In turn, the metabolic syndrome is a combination of risk factors,
including high blood lipids, abdominal obesity, and a tendency to diabetes.
The association between NAFLD, NASH, and the metabolic syndrome is a great
cause for concern because people with the metabolic syndrome are at
increased risk for type 2 diabetes and cardiovascular disease, including
heart attack and stroke.
According to Dr. Fabio Marra, Associate Professor of Medicine at the
University of Florence, "When I see a patient with a fatty liver, I have to
consider all the other risk factors for cardiovascular diseases and try to
intervene aggressively to limit the effects of those other factors, because
accumulating data indicate that the fatty liver may be itself an additional
risk factor."
The precise prevalence of NAFLD and NASH within individual countries is
elusive. Large scale epidemiological studies are still needed, and
definitive laboratory tests to identify patients with NASH are unavailable.
At present, a biopsy of the liver is the only accepted diagnostic method.
Despite these limitations, the best current estimates suggest that in the
general population NAFLD can be found in one-fourth to one-third of adults
in Western countries. One U.S. study of children who died as a result of
accidents found that 13% had NAFLD.
While a number of risk factors have been identified, the foregoing
percentages rise most dramatically among people who are obese. For example,
studies have found NAFLD in 84% to 96% of patients undergoing bariatric
surgery. For these reasons, NAFLD and NASH are seen to be increasing as
poor dietary habits and sedentary lifestyles become more widespread.
Although NAFLD and NASH have not to date been included as components of
the metabolic syndrome, increasingly the onset of NAFLD is being viewed by
experts as an early event in the development of insulin resistance and
therefore as an indicator or predictor of future metabolic syndrome.
Among key unanswered questions: Why do some people with NAFLD live out
their lives unaffected by their condition of having a fatty liver, while
others go on to develop NASH and cirrhosis, or diabetes and/or
cardiovascular disease?
At present, there are no specific therapies for NASH. Among the chief
recommendations offered to patients are to lose weight gradually
(particularly if one is obese) and to increase physical activity, to eat a
healthy diet, and to avoid alcohol.
About EASL
The European Association for the Study of the Liver (EASL) aims to
promote investigation into liver disease and improve the treatments that
currently exist for these conditions. The association, through its annual
meetings, seeks to inform and educate both the scientific community as well
as society in general about the increasing occurrence of liver diseases
along with the importance of understanding these conditions in order to
treat and prevent them. Since its creation in 1966, the EASL congress has
been hosted in 20 different European countries. Currently the association
has over 1400 members and the annual congress attracts over 6000 delegates
from over 65 countries each year.
European Association for the Study of the Liver
easl.ch