NASH Non-alcoholic steatohepatitis

The progressive form of non‑alcoholic fatty liver disease, known as non‑alcoholic steatohepatitis (NASH), is a growing concern as the global prevalence of obesity and type 2 diabetes continues to rise.

NASH Non-alcoholic steatohepatitis Policy NASH Liver Disease


Rising prevalence of obesity and type 2 diabetes has exacerbated the growth of non‑communicable diseases, placing a considerable burden on the people affected and the world’s health systems. Despite general awareness of the risks posed by obesity, an aspect too often neglected is its impact on the liver.

Non-alcoholic fatty liver disease (NAFLD) is a chronic progressive liver disease estimated to affect one in four people worldwide. Its more progressive form is non-alcoholic steatohepatitis (NASH), which affects up to one fifth of people with NAFLD. The prevalence of these diseases has increased in recent years and will likely continue to grow in line with the rise in obesity and type 2 diabetes.

NASH can lead to liver cirrhosis and liver cancer. Non‐specific symptoms mean diagnosis of NASH is complex – in many people NASH is identified when advanced liver damage has already occurred. Definitive diagnosis requires a liver biopsy, which is an invasive, costly and sometimes painful procedure. To ensure NASH is diagnosed earlier, we need reliable, non-invasive diagnostic tests that can be used in primary care.

There are currently no approved medicines to treat NASH. The cornerstone of NASH management are lifestyle changes aimed at weight loss. Sustained weight loss has been shown to be highly beneficial, but many people may find it difficult to achieve and maintain the necessary lifestyle changes.

With the prevalence of NASH on the rise, there is an urgent need to improve our understanding of the disease in order to implement effective policies to reduce its burden.

What we’ve achieved

HPP assembled a steering committee of nine clinical and health advocacy experts to develop a policy report, which aims to inform a sustainable policy response to the anticipated rise of NASH in years to come. Focusing on Europe and the Middle East, it offers up-to-date analysis of the epidemiology and impact of NASH, and highlights key strategic issues to aid clinical management and health-system preparedness from a policy perspective.

The report proposes five recommendations for action for policymakers:

  1. Create education and awareness campaigns to improve understanding of the importance of good liver health
  2. Include liver conditions in public health policies and action plans on obesity and other related conditions
  3. Improve data collection to achieve a better understanding of NASH prevalence, economic costs and impact on quality of life
  4. Educate primary care providers on NAFLD and NASH and develop clear care pathways to encourage more effective diagnosis and high-quality care
  5. Establish new multidisciplinary models of care for NAFLD and NASH.

The report, Creating a policy narrative around NASH in Europe and the Middle East, was launched on 12 June 2019 to coincide with International NASH Day. Eight national reports were also developed for internal use in the relevant countries.

Key partners and stakeholders

Steering committee members:

  • Quentin M. Anstee, Professor of Experimental Hepatology, Institute of Cellular Medicine, Newcastle University, UK
  • Farhana Bin Lootah, Internal Medicine Specialist at Imperial College London Diabetes Centre, UAE
  • Donna R. Cryer, President and CEO, Global Liver Institute, US
  • Hannes Hagström, Consultant in Hepatology, Karolinska University Hospital, Sweden
  • Jeffrey V. Lazarus, Associate Research Professor, Barcelona Institute for Global Health, University of Barcelona, Spain
  • Michael P. Manns, President, Hannover Medical School, Germany
  • Manuel Romero-Gómez, Professor of Medicine, UCM Digestive Diseases, Virgen del Rocio University Hospital, Spain
  • Lawrence Serfaty, Chief of the Liver Diseases Department, Hautepierre Hospital, University of Strasbourg, France
  • Zobair M. Younossi, Professor and Chairman of Department of Medicine, Inova Fairfax Medical Campus, US

Project funding

The project was initiated and funded by Gilead Sciences Europe. Gilead had no input into the report content.