Preparing for the NASH Epidemic: A Call to Action

Abstract

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common conditions with a rising burden. Yet there are significant management gaps between clinical guidelines and practice in patients with NAFLD and NASH. Further, there is no single global guiding strategy for the management of NAFLD and NASH. The American Gastroenterological Association, in collaboration with 7 professional associations, convened an international conference comprising 32 experts in gastroenterology, hepatology, endocrinology, and primary care providers from the United States, Europe, Asia, and Australia. Conference content was informed by the results of a national NASH Needs Assessment Survey. The participants reviewed and discussed published literature on global burden, screening, risk stratification, diagnosis, and management of individuals with NAFLD, including those with NASH. Participants identified promising approaches for clinical practice and prepared a comprehensive, unified strategy for primary care providers and relevant specialists encompassing the full spectrum of NAFLD/NASH care. They also identified specific high-yield targets for clinical research and called for a unified, international public health response to NAFLD and NASH.Nonalcoholic fatty liver disease (NAFLD)-hepatic steatosis on imaging or histology in the absence of known causes-is rapidly becoming the most common cause of chronic liver disease worldwide (1). NAFL is histologically defined as the presence of $5% hepatic steatosis without evidence of hepatocellular injury, and nonalcoholic steatohepatitis (NASH) is defined as the presence of $5% hepatic steatosis and inflammation with hepatocyte injury (e.g., ballooning), with or without fibrosis (2). At least 20%-30% of patients with NAFLD develop NASH, which can lead to cirrhosis and associated complications, including hepatocellular cancer (HCC) (2). NASH is also associated with an increased risk of cardiovascular disease (3) and increased cardiovascular and liver-related mortality (4-6).Although most patients with NAFLD and NASH have traditionally been diagnosed and managed by hepatologists, the recent availability of noninvasive diagnostic procedures is expanding the role of other health care professionals likely to see patients with these conditions, particularly gastroenterologists, endocrinologists, obesity medicine specialists, and primary care providers (PCPs). Previous research has suggested that effectively treating NASH will require more education about both NAFLD and NASH among specialists and PCPs (7). Some published data also showed significant management gaps between published guidance and clinical practice in patients with NAFLD and NASH (8,9). Much of this disparity could come from a lack of recognition of the importance of NAFLD/NASH and an absence of a unified strategy that encompasses all disciplines involved in managing these patients across the full disease spectrum.To address this need, the American Gastroenterological Association (AGA) conducted a needs asses...

Diabetes and cirrhosis: Current concepts on diagnosis and management

“…Both conditions promote the development of NAFLD, soon to be the most common cause of cirrhosis worldwide 1,28. There have recently been “calls to action” for an early diagnosis of NAFLD and for screening all patients with T2DM, with multidisciplinary efforts for a more proactive approach in the primary care and diabetes clinic settings,96–99 as well as from consensus statements 11–13,100–103. In 2016, the EASL-EASD-EASO guidelines100 recommended that persons with NAFLD be screened for diabetes.…”

The diagnosis and management of nonalcoholic fatty liver disease: A patient‐friendly summary of the 2018 AASLD guidelines

“…This includes two other classes of medications that are used to lower blood sugar, and some examples include dulaglutide, semaglutide, liraglutide, dapagliflozin, empagliflozin, and canagliflozin. 2 Deciding on which medication to take for diabetes depends on many patient specific factors and will require a decision with a doctor. Treatments are summarized in Table 1.…”

A comparison of NAFLD and MAFLD diagnostic criteria in contemporary urban healthy adults in China: a cross-sectional study

“…As a group of acquired metabolic stress-related disorders, most simple fatty livers are benign, whereas a subset of patients may develop NASH, which is at risk of progression to liver fibrosis and associated complications, including hepatocellular cancer[ 28 ]. Therefore, timely detection of NASH and progressive liver fibrosis is very important[ 29 ].…”