Nonalcoholic steatohepatitis

Abstract

Nonalcoholic steatohepatitis (NASH) is an important medical condition and there is great public health concern related to its increasing incidence and potential implications for the development of end-stage liver disease. NASH represents a progression beyond simple lipid deposition in the liver parenchyma, requiring histologic evidence for hepatocyte injury such as ballooning degeneration, Mallory bodies, and/or pericellular fibrosis that can potentially lead to progressive liver injury and eventually cirrhosis. It is believed that several insults contribute to the evolution of hepatic injury such as insulin dysregulation, lipid deposition, oxidative free radicals, and lipid perioxidation. Initial treatment protocols for NASH focus on various aspects of injury in an attempt to control insulin imbalances, improve lipid regulation, reduce free radicals, and ameliorate the inflammatory process. No therapy is conclusively beneficial in all individuals, but preliminary data suggest several approaches that hold promise.

A Novel Diagnostic Biomarker Panel for Obesity-related Nonalcoholic Steatohepatitis (NASH)

“…A subtype of NAFLD, nonalcoholic steatohepatitis (NASH), can follow a progressive course. In fact, the progression is associated with age, impaired glucose metabolism, and insulin resistance [1][2][3]. The cost associated with managing patients with NASH can be substantial, emphasizing the importance of early diagnosis [4].…”

Current management of patients with nonalcoholic fatty liver disease

“…Hepatomegaly may only be seen in a few patients [20]. Patients are typically obese (39-93%) and have type II diabetes mellitus (21-55%) [19].…”

“…It is important to note that clinical, laboratory and radiologic modalities are not accurate enough to establish the final diagnosis of NASH, so though liver biopsy and histological diagnosis are considered to be 'suboptimal' gold standards to grade the stages of the disease into simple steatosis alone (also called NAFL) or NASH [3,31,32] they are necessary. A diagnosis of NASH is made when hepatic steatosis is seen in conjunction with hepatocyte damage in a centrilobular pattern [20,33]. However, several NASH-specific biomarkers have recently been developed that may help in the diagnosis of NAFLD.…”

“…Weight loss can improve IR and may also have an antioxidant effect. Weight loss can be achieved by diet and lifestyle modification or by weight reduction surgery [20,57,58]. From NAFLD standpoint, a safe, sustainable and reasonable goal is to lose 10% of body weight over 6 months regardless of the weight loss method (e.g., diet, increased physical activity, surgery or a combination) [4,57].…”

“…Novel effective and safe pharmacological agents that are capable of controlling risk factors contributing to NAFLD and CVD remain to be established; however, previous reviews have categorized the pharmacologic agents in NAFLD as insulin-modulating, lipid-modulating, fibrosis-modulating and oxidative stress-modulating therapies [20,58]. Insulinmodulating treatment aims to enhance insulin sensitivity.…”