Unmasking a Stealth Killer: The Need for Increased Awareness of NASH

Excerpt

Awareness of a disease, particularly of a liver disease (LD), before it grows to an epidemic level should be a public health concern for many valid reasons. First, a LD that can arise from lifestyle or from genetic origins may be treated successfully at an early stage when it is suitably diagnosed, tracked by public health officials, and treated by frontline practitioners. Second, the increasing prevalence of obesity in the USA has made awareness of liver diseases such as nonalcoholic fatty liver disease (NAFLD) even more essential for the success of the nation’s healthcare system. However, disease awareness must be a two-way street not just in the medical lexicon but also in the public domain. It requires the involvement of both the patient and the physician for the prevention of late-stage liver disease and the restoration of optimal health. In the case of NAFLD, the broad spectrum of liver damage it comprises must be an issue of concern for health administrators and their patients. The deposition of fat droplets in liver hepatocytes causes simple steatosis (i.e., NAFL), which might progress to steatohepatitis (i.e., NASH), an inflammatory stage of the disease in which cytokines and immune cells are involved. The difficulty so far for researchers and policymakers has been the accurate estimation of the prevalence of NAFLD/NASH in the population since these diseases are asymptomatic. Although NAFLD and NASH may be reversed if managed early with profound lifestyle changes including strict adherence to an exercise regimen and a weight reduction diet, the next course of the disease is punctuated by advancing fibrosis that leads to cirrhosis, which is usually irreversible. Years later, the organ may deteriorate into end-stage liver disease (ESLD) or hepatocellular carcinoma, (HCC) often eventuating in liver transplantation or death [1]. …