Nonalcoholic Steatohepatitis: Risk Factors and Diagnosis
Nonalcoholic Steatohepatitis: Risk Factors and Diagnosis
Nonalcoholic steatohepatitis (NASH) represents the progressive form of nonalcoholic fatty liver disease with greater potential to lead to liver-related morbidity and mortality. Diagnosing NASH mandates more intensive clinical management and consideration for clinical trials. Currently, the diagnosis of NASH requires a liver biopsy, which is invasive, with drawbacks in sampling and interpretation error. Clinical risk factors for NASH include diabetes and the metabolic syndrome; however, these are not sufficiently predictive of the condition by themselves. Routine liver aminotransaminase levels are not reliable; however, novel plasma hepatocyte apoptosis markers, either alone or in combination with clinical risk factors, are potential noninvasive diagnostic tools for the future.
Nonalcoholic steatohepatitis (NASH) refers to the histological changes of hepatic steatosis, inflammation and hepatocellular damage that is not caused by excessive alcohol ingestion. The definition of excessive alcohol consumption is generally thought to be greater than 20 g/day for females and 30 g/day for males. NASH is most commonly associated with underlying insulin resistance, and thus is frequently present in subjects who are overweight or obese or who have Type 2 diabetes mellitus. NASH forms part of a histological spectrum of nonalcoholic fatty liver disease (NAFLD), which includes fatty liver in the absence of liver injury or inflammation (simple steatosis). Together NASH and simple steatosis collectively affect between 9 and 30% of the developing and developed countries respectively, making NAFLD the most common liver condition in the world. Whilst simple steatosis is thought to be a relatively benign entity, NASH has the potential to lead to morbidity and mortality and will be the focus of this article.
Abstract and Introduction
Abstract
Nonalcoholic steatohepatitis (NASH) represents the progressive form of nonalcoholic fatty liver disease with greater potential to lead to liver-related morbidity and mortality. Diagnosing NASH mandates more intensive clinical management and consideration for clinical trials. Currently, the diagnosis of NASH requires a liver biopsy, which is invasive, with drawbacks in sampling and interpretation error. Clinical risk factors for NASH include diabetes and the metabolic syndrome; however, these are not sufficiently predictive of the condition by themselves. Routine liver aminotransaminase levels are not reliable; however, novel plasma hepatocyte apoptosis markers, either alone or in combination with clinical risk factors, are potential noninvasive diagnostic tools for the future.
Introduction
Nonalcoholic steatohepatitis (NASH) refers to the histological changes of hepatic steatosis, inflammation and hepatocellular damage that is not caused by excessive alcohol ingestion. The definition of excessive alcohol consumption is generally thought to be greater than 20 g/day for females and 30 g/day for males. NASH is most commonly associated with underlying insulin resistance, and thus is frequently present in subjects who are overweight or obese or who have Type 2 diabetes mellitus. NASH forms part of a histological spectrum of nonalcoholic fatty liver disease (NAFLD), which includes fatty liver in the absence of liver injury or inflammation (simple steatosis). Together NASH and simple steatosis collectively affect between 9 and 30% of the developing and developed countries respectively, making NAFLD the most common liver condition in the world. Whilst simple steatosis is thought to be a relatively benign entity, NASH has the potential to lead to morbidity and mortality and will be the focus of this article.
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