WHO IS AT RISK FOR NASH?

PEOPLE WITH OBESITY

Both NASH and NAFLD are highly prevalent in populations suffering from obesity, but exact figures remain difficult to estimate. A study analyzing 12 observational and transversal studies, involving a total of 1,620 patients with severe obesity (BMI>40), showed that 91% had NAFLD (range:85-98%) and 37% had NASH (range: 24-98%).1

In another study quoted in American Association for the Study of Liver Diseases (AASLD) Practice Guidelines 2018, 80.2% of individuals with BMI > 35mg/m2 had obesity-related liver disease (steatosis, or NASH and/or fibrosis).2-3

NAFLD: 70% or more4
NASH: 25-30%5

LOOKING FORWARD

Obesity has reached epidemic proportions over the last 30 years. And its prevalence continues to increase. According to the Organization for Economic Cooperation and Development (OECD), 47% of adults in the United States will suffer from obesity by 2030, compared to 37.7% in 2014. This represents a 25% increase in obesity by 2030.6

PEOPLE WITH TYPE 2 DIABETES

More than 500 million people are affected by type 2 diabetes worldwide.7 According to several studies and AASLD Practice Guidelines, around one third to two thirds of diabetic patients have NAFLD.2

NAFLD: 70% or more2,8
NASH: 25-30%5

LOOKING FORWARD

Worldwide diabetes rates are expected to grow by about 55% by the year 2035, according to the International Diabetes Federation, which means that the population at risk of NAFLD/NASH will increase dramatically over the next few decades.2,9

ESTABLISHED RISK FACTORS INCLUDE2

  • Genetic variation linked to patatin-like phospholipase domain-containing protein 3 (PNPLA3)
  • Obesity
  • Type 2 diabetes
  • Dyslipidemia
  • Hypertension
  • Insulin resistance
  • Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels
  • Metabolic syndrome (any three of the five features):
    • Impaired fasting glucose
    • Raised triglyceride level
    • Low high-density lipoprotein (HDL)
    • Increased waist circumference
    • High blood pressure

CONDITIONS ASSOCIATED WITH NAFLD2

  • Obstructive sleep apnea
  • Colorectal cancer
  • Osteoporosis
  • Psoriasis
  • Endocrinopathies
  • Hypothyroidism
  • Polycystic ovary syndrome independent of obesity

HOW IS NASH DIAGNOSED?

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References

  1. Machado M, Marques-Vidal P, Cortex-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600-606.
  2. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.
  3. Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan A. Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery. Surg Obes Relat Dis. 2015;11(1):137-41.
  4. Dhir G,Cusi K. Glucagon like peptide-1 receptor agonists for the management of obesity and non-alcoholic fatty liver disease: a novel therapeutic option. J Investig Med. 2018;66(1):7-10.
  5. Anstee QM1, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330-44.
  6. Organisation for Economic Co-operation and Development (OECD). Obesity Update 2017. https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf. Published 2017. Accessed October 8, 2019.
  7. Kaiser AB, Zhang N, Van Der Pluijm W. Global prevalence of Type 2 diabetes over the next ten years. Diabetes. 2018;67(Suppl 1). https://diabetes.diabetesjournals.org/content/67/Supplement_1/202-LB. Accessed October 10, 2019.
  8. Bril F, Cusi K. Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: a call to action. Diabetes Care. 2017;40(3):419-430.
  9. Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103:137-149.