From the Guidelines
The incidence of Nonalcoholic Steatohepatitis (NASH) is estimated to be around 25% of the population in many developed countries, with approximately 37% of adults in the United States having nonalcoholic fatty liver disease (NAFLD), while the incidence of Hepatitis C Virus (HCV) related liver disease is not directly stated in the provided evidence, but it is known that patients with NASH are at increased risk of accelerated fibrosis progression and hepatocellular carcinoma development when coinfected with HCV 1.
Key Points
- Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from steatosis to nonalcoholic steatohepatitis (NASH) and can progress to cirrhosis and liver-related complications including hepatocellular carcinoma (HCC) and liver failure 1.
- The prevalence of NAFLD is estimated to be around 25% of the population in many developed countries, with approximately 37% of adults in the United States having NAFLD, and as many as 70% of individuals with type 2 diabetes (T2D) having NAFLD 1.
- Patients with NAFLD have an increased risk of overall mortality compared with the general population, and common causes of death include cardiovascular disease, malignancy, and liver-related complications 1.
- The management of patients with NAFLD and NASH requires a multidisciplinary approach, including primary care, gastroenterology, hepatology, obesity management, and endocrinology, to co-manage the hepatic manifestations of the disease, as well as the comorbid metabolic traits and cardiovascular risk 1.
Management
- For patients with NASH, weight loss through diet and exercise, with a target of 7-10% body weight reduction, is recommended, as well as regular monitoring with liver function tests, elastography for fibrosis assessment, and hepatocellular carcinoma surveillance in cirrhotic patients 1.
- Vitamin E (800 IU daily) may be considered for non-diabetic NASH patients without cirrhosis, but the evidence for this is not as strong as for weight loss and lifestyle modifications 1.
- The relationship between NASH and HCV involves shared pathways of insulin resistance, oxidative stress, and inflammatory responses that can synergistically damage the liver, and treating the HCV infection with direct-acting antivirals (DAAs) is recommended for patients with both conditions 1.
From the Research
Incidence of Nonalcoholic Steatohepatitis (NASH)
- NASH is the second leading cause of liver transplantation in the US with a high risk of liver-related morbidities and mortality 2
- NASH is a progressive and chronic liver disorder with a significant risk for the development of liver-related morbidity and mortality 3
- The prevalence of NASH is increasing rapidly, and it is the most common cause of liver disease in Western populations 4
Incidence of Hepatitis C Virus (HCV) related liver disease
- There is no direct evidence in the provided studies regarding the incidence of HCV related liver disease
Comparison of NASH and HCV related liver disease
- NASH is a subtype of nonalcoholic fatty liver disease, while HCV is a viral infection that can cause liver disease 3, 5
- Both NASH and HCV can lead to liver fibrosis and cirrhosis, but the underlying causes and pathophysiology are different 4, 5
Treatment and Management of NASH
- Lifestyle modification is the primary recommendation for the treatment of NASH, but it is often difficult to sustain and may be insufficient to cure NASH 2, 3
- Pharmacotherapies, such as vitamin E and pioglitazone, are recommended in patients with NASH, but concerns about their side effects remain 2, 6
- Bariatric surgery may be recommended for morbidly obese patients with NASH, and it can resolve NASH in some patients 2