Suzanne Wait - The Health Policy Partnership

Suzanne Wait

NASH: the liver disease everyone will be talking about

12 June 2019

graphic of a liver in a white geometric pattern on a teal background

Non-alcoholic liver disease is a common and growing problem for our health systems, yet few people have heard of it. How can we secure its place on the policy agenda?

Today, 12 June, is International NASH Day – and we are launching a policy report to raise awareness of non-alcoholic steatohepatitis (NASH) and explore its implications for our health systems in years to come.

It’s probably fair to say that most people have never heard of NASH. When people think of liver disease, they tend to think of cirrhosis caused by high consumption of alcohol, or hepatitis B or C, which are caused by viruses. NASH is very different – it is caused by obesity and closely linked to type 2 diabetes and metabolic syndrome.

What is NASH and how common is it?

NASH is the progressive form of a chronic liver disease called non-alcoholic fatty liver disease (NAFLD), which is characterised by the build-up of fat in the liver (steatosis). Globally, one in four (25%) people have NAFLD. Although a healthy liver should ideally contain little or no fat, NAFLD does not usually cause any harm on its own. However, this is not the case for NASH.

Why is NASH harmful?

It is estimated that one in five (20%) people with NAFLD develop NASH, which occurs when fat accumulation in the liver is accompanied by liver cell injury and inflammation.

NASH can lead to serious liver damage, including cirrhosis and liver cancer, and potentially the need for a liver transplant. But the impact of NASH is not limited to the liver. NAFLD and NASH are major risk factors for other chronic diseases related to obesity, such as type 2 diabetes, cardiovascular disease (CVD), cancer and chronic kidney disease.

Why are we starting to talk about NASH now?

The prevalence of NASH has increased over the past 15 years due to rising rates of obesity and type 2 diabetes – and is expected to continue rising in parallel to these conditions.

As prevalence grows, NASH places escalating financial pressure on health systems. It also has an important impact on society, in terms of lost work productivity and lower quality of life for people affected.

We need more data on NASH to better understand its prevalence and far-reaching implications.

How can policymakers best prepare health systems?

With the rising toll of NASH, there is a clear public health imperative to reduce its global burden. We need to include NAFLD and NASH in policies on obesity and related conditions.

Improving public awareness will be crucial, and we must also promote greater understanding of NAFLD and NASH among healthcare professionals outside of the hepatology community. NASH is difficult to diagnose because symptoms such as fatigue and abdominal pain can easily be mistaken for something else. A multidisciplinary approach to NASH has been shown to have a beneficial impact on liver disease, metabolic conditions and CVD in people with NAFLD and type 2 diabetes; however, multidisciplinary NASH care is not widely available in practice.

Investment in better diagnosis and treatment will also be key. Currently, there are no reliable non-invasive tools to confirm a diagnosis of NASH; this can only be done by liver biopsy – an invasive, costly and often painful procedure. And there are no treatments specifically designed to decrease progression of NASH.

More data on NASH are needed to better understand its prevalence and far-reaching implications. Currently, limited data on NASH hinder workforce planning and our ability to prepare health systems to meet the needs of people with NAFLD and NASH.

Raising awareness: International NASH Day

Underpinning these recommendations is the need for all of us to recognise the importance of good liver health. Marking International NASH Day is a central part of this effort.

To mark this year’s International NASH Day, we’ve launched a new report, Creating a policy narrative around NASH in Europe and the Middle East, which provides a comprehensive review of NASH in Europe and the Middle East from a policy perspective. It lays the foundation for a measured policy response anticipating the rise of NASH and is grounded in up-to-date estimates of the epidemiology and impact of NASH. It was developed by HPP under the leadership of an international independent steering committee of experts on NASH and liver disease across Europe and the Middle East.

It is our hope that our report will contribute to building greater awareness of NASH and drive policy change to address this critical public health challenge in years to come.

This blog post refers to a report that has been initiated and funded by Gilead Sciences Europe. Gilead has had no input into the report content. To find out more about the new report, please see the NASH project page.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.