Nonalcoholic Steatohepatitis

Abstract

ImportanceNonalcoholic steatohepatitis (NASH) is the inflammatory subtype of nonalcoholic fatty liver disease (NAFLD) and is associated with disease progression, development of cirrhosis, and need for liver transplant. Despite its importance, NASH is underrecognized in clinical practice.ObservationsNASH affects an estimated 3% to 6% of the US population and the prevalence is increasing. NASH is strongly associated with obesity, dyslipidemia, type 2 diabetes, and metabolic syndrome. Although a number of noninvasive tests and scoring systems exist to characterize NAFLD and NASH, liver biopsy is the only accepted method for diagnosis of NASH. Currently, no NASH-specific therapies are approved by the US Food and Drug Administration. Lifestyle modification is the mainstay of treatment, including dietary changes and exercise, with the primary goal being weight loss. Substantial improvement in histologic outcomes, including fibrosis, is directly correlated with increasing weight loss. In some cases, bariatric surgery may be indicated to achieve and maintain the necessary degree of weight loss required for therapeutic effect. An estimated 20% of patients with NASH will develop cirrhosis, and NASH is predicted to become the leading indication for liver transplants in the US. The mortality rate among patients with NASH is substantially higher than the general population or patients without this inflammatory subtype of NAFLD, with annual all-cause mortality rate of 25.56 per 1000 person-years and a liver-specific mortality rate of 11.77 per 1000 person-years.Conclusions and RelevanceNonalcoholic steatohepatitis affects 3% to 6% of the US population, is more prevalent in patients with metabolic disease and obesity, progresses to cirrhosis in approximately 20% of cases, and is associated with increased rates of liver-specific and overall mortality. Early identification and targeted treatment of patients with nonalcoholic steatohepatitis are needed to improve patient outcomes, including directing patients toward intensive lifestyle modification to promote weight loss and referral for bariatric surgery as indicated for management of obesity and metabolic disease.

Shifts in the bacterial community of supragingival plaque related to metabolic associated fatty liver disease

“…Known as indicators of hepatocellular damage, elevated serum levels of transaminases and transpeptidases are also main clinical manifestations of MAFLD [2]. Moreover, a decreased AST/ALT ratio is regarded as biomarker of progressive MAFLD [2]. In this study, a decreased AST/ALT ratio (P = 0.0142) as well as elevated GGT (P = 0.0084) were prevalent in MAFLD patients, suggesting the enrolled MAFLD patients had different degrees of hepatocellular damage.…”

“…Subjects in the MAFLD group had relatively higher TG levels and lower HDL-C levels, and thus higher TG/HDL-C ratios than the control group [14,15]. Moreover, ALT and GGT levels were relatively higher in the MAFLD group than the control group, revealing hepatocellular damage in MAFLD patients [2]. Because subjects with diabetes were excluded, there was no signi cant difference in FPG levels between the two groups, although FSI and HOMA-IR were signi cantly increased in the MAFLD group, indicating the prevalence of IR [12].…”

“…Known as indicators of hepatocellular damage, elevated serum levels of transaminases and transpeptidases are also main clinical manifestations of MAFLD [2]. Moreover, a decreased AST/ALT ratio is regarded as biomarker of progressive MAFLD [2].…”

“…Progressive hepatic brosis is a hallmark of advanced steatohepatitis and can lead to cirrhosis, liver failure, and hepatocellular carcinoma [2]. MAFLD is an emerging public health concern worldwide, with a global pooled prevalence, by imaging, of 25.24% [3].…”

Association of NAFLD Fibrosis Score with Subclinical Myocardial Remodeling in Patients with Type 2 Diabetes: A Cross-Sectional Study in China

“…Nonalcoholic fatty liver disease (NAFLD), de ned as excessive accumulation of triglycerides in hepatocytes with no evidence of alcohol abuse or other secondary causes, has become the most prevalent liver diseases worldwide [1]. It represents a spectrum of conditions from simple steatosis to nonalcoholic steatohepatitis (NASH), liver brosis and cirrhosis, and has been one of the top leading causes for end-stage liver disease and liver transplantation [2].…”