More About NAFLD/NASH
What Is NASH?
The term NAFLD covers a range of liver disease progression. When fatty liver disease moves on to a more severe level of liver injury, it is called nonalcoholic steatohepatitis (NASH). Non-alcoholic steatohepatitis (NASH) has become the most common form of chronic liver disease in the developed world. NAFLD/NASH is likely the most common liver disease in the United States and is thought to be related to obesity or diabetes. Estimates of the prevalence of NAFLD in adults range from 17% to 46%. NASH has been found in 3-13% of adults, with its prevalence approaching 50% in patients with severe obesity and diabetes.
NASH Treatment Options
Because obesity, poor dietary habits, and a sedentary lifestyle predispose to the development of NASH, the primary therapeutic intervention is to address these factors by promoting gradual and sustained weight reduction through a balanced, calorically restricted diet composed of healthy food choices coupled with increased physical activity. Although the benefit of lifestyle modification has not been proven in large rigorous clinical trials, enough data have been accumulated from smaller studies to justify this approach.
Pharmacologic treatments have been sought but none has proved universally efficacious. This may be related to the fact that the histopathological changes seen on liver biopsy currently described as NASH may be the result of multiple pathogenic mechanisms acting in concert to varying degrees. Based on the prevalence and risk of progression of NASH to cirrhosis and cancer, the burden of significant disease is large and drug therapy to prevent or treat NASH is needed. A number of thorough reviews have documented the results of the published drug studies for NASH. The NASH CRN recently published the results of the PIVENS trial; a large, multicenter, placebo controlled randomized trial that showed benefits of both pioglitazone and vitamin E in a subset of patients. Further analyses are underway to determine if any pretreatment clinical or pathological findings predict who might respond to these therapies.
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