A recent analysis published in the journal HEPATOLOGY suggests that the global prevalence of nonalcoholic fatty liver disease (NAFLD) is about 25 percent. According to the lead author, Zobair M. Younossi, MD, MPH, FAASLD, NAFLD is rapidly becoming the leading cause of chronic liver disease and the most common indication for liver transplantation in the U.S.

Dr. Younossi will discuss the burden of NAFLD and its progression to nonalcoholic steatohepatitis (NASH) during Sunday’s AASLD State-of-the-Art Lecture NASH: Does My Liver Look Fat?

“[NAFLD is] already the second indication for liver transplantation and among the top three causes of liver cancer in the United States,” said Dr. Younossi, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research of Inova Health System in Falls Church, VA.

NAFLD is a spectrum of liver diseases that are unified around fat collection in the liver in the absence of alcohol and, according to Dr. Younossi, present a trifold burden: clinical, economic and those that are related to patient reported outcomes (PRO).

“The clinical burden has to do with the fact that it is very common, and a subgroup of these patients progress to NASH,” Dr. Younossi said. “We know that if you have fatty liver disease in the context of diabetes or components of metabolic syndrome, you are more likely to progress to cirrhosis. The increase in the prevalence of NAFLD and the increasing complications of NAFLD-related cirrhosis will contribute to its already tremendous clinical burden.”

The disease, specifically NASH and NASH fibrosis, also has a significant impact on patients’ health-related quality of life and work productivity, among other factors. This impact, Dr. Younossi said, not only adds to the PRO burden but also to the economic burden of NAFLD.

“Patients with fatty liver disease also have significant resource utilization on both the in-patient side as well as the outpatient side,” he said. “The disease actually costs society quite a bit of resources and money, leading to substantial economic burden. Fatty liver disease is also becoming more and more common in pediatric populations, which means the burdens of the disease will only grow over time.”

The diagnostic tests for identifying the type of fatty liver disease that could be associated with a bad prognosis or scarring of the liver are usually invasive, notably liver biopsy. There is currently no approved treatment regimen aside from lifestyle modifications.

Dr. Younossi will discuss ongoing efforts to develop non-invasive diagnostic tools, such as imaging or blood tests, to help diagnose the NASH subtype of the disease.
“There are a number of clinical trials ongoing right now to develop new therapeutic approaches and new drugs for treatment of NAFLD and NASH,” said Dr. Younossi, adding that it will likely be at least three to five years before an approved treatment is available.

“It’s really important for folks to understand the current burden of NAFLD and the tsunami coming up in terms of its impact. That’s really critical for all of the gastroenterologists, hepatologists, primary care physicians and diabetologists to understand,” he said. “Clinicians need to take the lead in promoting the importance of this disease, to learn what will be needed to deal with the complications of metabolic syndrome and fatty liver disease, and how to plan for it.”

Please refer to the DDW Mobile App or the Program section in Sunday’s DDW Daily News for additional details on this and other DDW^® events.