Study: Understanding the Outcomes of NAFLD and NASH

Currently, there are no FDA-approved treatments for nonalcoholic fatty liver disease (NAFLD) or its more advanced version: nonalcoholic steatohepatitis (NASH). This is partly due to the lack of understanding surrounding this disease and its outcomes. Arun Sanyal, M.D., aims to address this issue and has recently published a study in the New England Journal of Medicine to further the knowledge of these liver diseases.

About NALFD and NASH

Nonalcoholic fatty liver disease occurs when fat builds in the liver of someone who drinks little to no alcohol. The accumulation of fat causes pain in the upper right abdomen and fatigue, and as more builds up, symptoms progress to a swollen abdomen, jaundice, enlarged blood vessels and spleen, and red palms. Managing this condition is integral, as it can lead to complications like cardiovascular disease, liver failure, cirrhosis, and liver cancer.

Medical professionals do not know why some people develop this condition while others do not, but they have identified risk factors: obesity, type 2 diabetes, insulin resistance, high blood sugar, sleep apnea, polycystic ovary syndrome, high cholesterol, high levels of fat in the blood, being of older age, and an underactive thyroid or pituitary gland. Lifestyle changes are the best way to treat this condition, such as losing weight, eating a healthy diet, and exercising regularly. A liver transplant may be necessary if cirrhosis has occurred.

NAFLD may also advance into NASH, which sees an accumulation of fat, inflammation, and damage in the liver. This results in symptoms like jaundice, weakness, fatigue, itching, swelling in the legs and abdomen, mental confusion, weight loss, loss of appetite, nausea, vomiting, abdominal pain, and spider-like blood vessels. Like NAFLD, lifestyle changes are the best route for treatment. Doctors recommend losing weight, avoiding alcohol, lowering cholesterol, controlling diabetes, and maintaining a healthy diet and exercise regimen.

About the Study

This study establishes the first clear picture of the outcomes of NAFLD, which is integral for diagnosis and treatment. At the moment, there are no therapies indicated for NAFLD or NASH that have been approved by the FDA, and liver transplants are becoming more and more necessary to treat patients. In fact, this increase in the need for transplants has been putting a strain on supply.

One portion of Sanyal’s study stresses the need for increased screening and diagnosis of these conditions, which would lead to earlier intervention and better outcomes, therefore lessening the need for liver transplants. In Sanyal’s words, this study contributes to the research supporting the American Diabetes Association’s new guidelines regarding screening, helping to “make the screening more mainstream.”

In order to find this information, Sanyal and other researchers followed 1,700 patients with liver disease for a median of four years. Findings include:

  • Patients with advanced fibrosis are at a higher risk of death
    • This risk increases even more after fluid accumulation in the abdomen or gastrointestinal hemorrhaging, alongside progressive deterioration of brain function
  • Treating diabetes is not adequate treatment for fibrosis of the liver

Looking Forward

We’re currently facing large gaps in both knowledge and awareness when it comes to NAFLD and NASH, a gap that Sanyal and colleagues at Virginia Commonwealth University aim to close. With an improved understanding of these diseases, there is a better chance of developing viable treatment options.

As there are currently millions of Americans living with either stage three or four fibrosis or NASH, there is a severe unmet medical need. Research like Sanyal’s helps to push us closer to offering these people treatment.

Find the source article here.

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