Non-alcoholic steatohepatitis

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

Non-alcoholic steatohepatitis

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

Context

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 awareness of the risks of obesity, an aspect too often neglected is their impact on the liver.

NAFLD is a chronic progressive liver disease estimated to affect one in four people (25%) worldwide. Its more progressive form is NASH, which affects up to 20% 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, so many people with NASH are only identified once advanced liver damage has already occurred. Definitive diagnosis requires a liver biopsy, an invasive, costly and sometimes painful procedure, so there is a need for reliable non-invasive diagnostic tests that can be used in primary care.

There are currently no approved medicines for treatment of NASH. The cornerstone of NASH management is the adoption of 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 NASH in order to implement effective policies to reduce its burden.

%

Global prevalence of NAFLD is estimated to reach more than 28% by 2030

%

Up to 20% of people with NAFLD develop NASH

%

Up to 70% of people with obesity and type 2 diabetes will be affected by NAFLD

What we 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 estimates 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 key 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 was launched on 12 June 2019 to coincide with International NASH Day. Work on this project continues, with eight country reports currently in development.

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