How Can I Convince My Patients That NASH Is Serious?
How Can I Convince My Patients That NASH Is Serious?
When discussing the new diagnosis of obesity-related liver diseases with some of my patients, I offer encounter skepticism as to the severity. Can you provide data that I can share to emphasize the concern about the long-term impact of nonalcoholic steatohepatitis?
The concern is about nonalcoholic steatohepatitis is real -- and the "downstream" impact is significant and evidence-based. Multiple studies have documented that obese patients with fatty liver disease are at an increased risk for early morbidity and mortality. This effect begins during adolescence.
A study presented at Digestive Disease Week (DDW) 2012 evaluated the links among obesity, fatty liver, and cardiovascular risk in pediatric patients. They documented that obesity may in fact confer a risk burden for cardiovascular disease similar to that of patients with familial dyslipidemias. The atherogenic risk profile in patients with NASH is driven by multiple lipoprotein abnormalities, adipose tissue insulin resistance, and the severity of histologic abnormalities. Adipose tissue insulin resistance is closely associated with NASH, its severity, and atherogenic risk profile.
Another study reported at DDW 2012 showed that moderate to severe obstructive sleep apnea and hypoxia are common in obese patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD). Obstructive sleep apnea and hypoxia were also associated with more advanced fibrosis in patients of all ages.
A large multicenter cohort study presented at the European Association for the Study of the Liver meeting this year further documented that NAFLD is a predisposing condition for hepatocellular carcinoma. Of concern, NAFLD-associated hepatocellular carcinoma often occurs in the absence of cirrhosis. This may suggest the need to revise current guidelines, which recommend surveillance programs for cancer only in patients with cirrhosis.
Finally, a study presented at DDW 2012 reported the long-term follow-up of the liver-related death rate in patients with NAFLD and alcoholic-related fatty liver disease. Similar proportions of patients with NAFLD and alcoholic-related fatty liver disease developed cirrhosis. However, patients with NAFLD had a worse overall survival than patients with alcoholic-related fatty liver disease.
These sobering findings should clearly emphasize the long-term impact of obesity-related liver diseases, and they underscore the urgent need to enhance our efforts to reduce the trend in obesity rates and the prevalence of fatty liver disease.
Question:
When discussing the new diagnosis of obesity-related liver diseases with some of my patients, I offer encounter skepticism as to the severity. Can you provide data that I can share to emphasize the concern about the long-term impact of nonalcoholic steatohepatitis?
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Response from William F. Balistreri, MD Professor of Medicine, University of Cincinnati College of Medicine; Staff Physician, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio |
The concern is about nonalcoholic steatohepatitis is real -- and the "downstream" impact is significant and evidence-based. Multiple studies have documented that obese patients with fatty liver disease are at an increased risk for early morbidity and mortality. This effect begins during adolescence.
A study presented at Digestive Disease Week (DDW) 2012 evaluated the links among obesity, fatty liver, and cardiovascular risk in pediatric patients. They documented that obesity may in fact confer a risk burden for cardiovascular disease similar to that of patients with familial dyslipidemias. The atherogenic risk profile in patients with NASH is driven by multiple lipoprotein abnormalities, adipose tissue insulin resistance, and the severity of histologic abnormalities. Adipose tissue insulin resistance is closely associated with NASH, its severity, and atherogenic risk profile.
Another study reported at DDW 2012 showed that moderate to severe obstructive sleep apnea and hypoxia are common in obese patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD). Obstructive sleep apnea and hypoxia were also associated with more advanced fibrosis in patients of all ages.
A large multicenter cohort study presented at the European Association for the Study of the Liver meeting this year further documented that NAFLD is a predisposing condition for hepatocellular carcinoma. Of concern, NAFLD-associated hepatocellular carcinoma often occurs in the absence of cirrhosis. This may suggest the need to revise current guidelines, which recommend surveillance programs for cancer only in patients with cirrhosis.
Finally, a study presented at DDW 2012 reported the long-term follow-up of the liver-related death rate in patients with NAFLD and alcoholic-related fatty liver disease. Similar proportions of patients with NAFLD and alcoholic-related fatty liver disease developed cirrhosis. However, patients with NAFLD had a worse overall survival than patients with alcoholic-related fatty liver disease.
These sobering findings should clearly emphasize the long-term impact of obesity-related liver diseases, and they underscore the urgent need to enhance our efforts to reduce the trend in obesity rates and the prevalence of fatty liver disease.
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