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.