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NASH: Progression of a potentially life-threatening disease
Non-alcoholic fatty liver disease (NAFLD) is a collective term used to describe a group of conditions where there is an abnormal accumulation of fat in the liver in those who drink little to no alcohol. This may range from a non-serious condition called fatty liver to a potentially serious condition called non-alcoholic steatohepatitis or NASH.
The prevalence of NAFLD in the United States is reported to be between 10% and 30%, and the pooled overall global prevalence of NAFLD diagnosed by imaging was estimated to be greater than 25%. However, the exact prevalence of NAFLD and NASH in an adult population remains difficult to assess due to the lack of a cost-effective and widely available, minimally-invasive diagnostic test, and to the absence of specific symptoms before end-stages.
The liver is the largest solid organ in the body and it performs many essential functions, such as nutrient metabolism, protein synthesis, bile production, and glycogen storage. A healthy liver is blood-red with a smooth surface and contains 5% (or less) fat.
Fatty liver, or non-alcoholic hepatic steatosis, is observed in individuals who chronically consume excess calories and/or have a sedentary lifestyle, in the absence of significant alcohol consumption. Excess calories are stored in liver cells as lipids, resulting in a liver with fat content above 5% and a pale yellow color.
After enough excess fat has accumulated in the liver, chronic inflammation and cell death (ballooning) result in NASH. At this stage, patients have a higher risk of death from cardiovascular disease.
Chronic and continuous cell damage and ballooning result in the formation of fibrous scar tissue (fibrosis). Eventually, excessive scar formation will result in loss of liver function, a state known as cirrhosis or stage 4 fibrosis.
Patients with NASH-related cirrhosis are at higher risk of end-stage liver diseases, such as loss of liver function (decompensation), liver failure, and hepatocellular carcinoma (liver cancer). They are also at higher risk of death from cardiovascular disease and non-liver cancer.