First ever International NASH day is being observed on 12th June, 2018 the world over. Nonalcoholic steatohepatitis (NASH) is a severe form of fatty liver which occurs in around 15-20% of patients who have nonalcoholic fatty liver disease (NAFLD). NAFLD is the commonest liver disease the world over and occurs in patients who do not consume alcohol or take it in insignificant amounts but have risk factors like overweight or obesity, diabetes mellitus (high blood sugar), hypertension (high blood pressure) or dyslipidemia (abnormal blood lipids). In fact NAFLD is a lifestyle disease which is taking the shape of an epidemic affecting approximately 25-30% of general population; with higher prevalence in those with risk factors enumerated above. In a recent study done in PGIMER Chandigarh, prevalence of NAFLD in healthy population of Chandigarh was as high as 53% informed Dr Ajay Duseja, Professor in the department of Hepatology, PGIMER, Chandigarh. Sedentary lifestyle lead on to overweight and obesity and excess of fat accumulation in the body which gets re-distributed to other organs with liver being the favorite site leading on to fatty liver. Excess fat in the liver (fatty liver) in some patients lead on to inflammation (swelling) and fibrosis (scarring) in the liver which is technically called as NASH. Patients with more metabolic risk factors like overweight or obesity, diabetes mellitus, hypertension or dyslipidemia, so called metabolic syndrome are at higher risk of developing NASH. In addition various other factors like genetics and small intestinal bacteria may also play a role in determining the development of NASH amongst all patients with NAFLD. Unlike patients with only fatty liver, NASH is a progressive disease which can damage the liver by causing cirrhosis liver and liver cancer and will soon become the most common indication for liver transplantation. In fact NASH is the most cause of cryptogenic cirrhosis and cryptogenic liver cancer where all other causes of these diseases have been excluded, explained Dr Duseja. In a study done in the department few years back, patients with cryptogenic cirrhosis and cryptogenic liver cancer were found to have higher prevalence of overweight/obesity, diabetes mellitus and dyslipidemia in comparison to patients with virus hepatitis associated cirrhosis and liver cancer informed Dr Duseja. Higher prevalence of metabolic risk factors in those patients suggested NASH as the possible cause which probably went un-noticed in them for many years. In fact NAFLD or NASH can be silent disease in many patients and come to attention only when it has taken the shape of a serious disease like cirrhosis or liver cancer. Initially stages of fatty liver are usually asymptomatic and patients usually come to attention while being worked for abdominal pain or other symptoms or while evaluation for rise in liver enzymes or during executive check up explained Dr Duseja. Ultrasound is the commonest modality which is used to diagnose fatty liver and is fairly reliable. But he emphasized that all patients with fatty liver on ultrasound are not same and all efforts must be made to assess the severity of liver disease with various non-invasive tests or liver biopsy so as to pick up the serious form of fatty liver which is called NASH. The prognosis, outcome and treatment is different in patients with NASH in comparison to those with only fat in the liver. Lifestyle modifications and reduction in body weight with the help of exercise and control of diet is recommended in all overweight patients in addition to control of other risk factors like diabetes mellitus, hypertension and dyslipidemia. In addition few drugs are used selectively in patients with NASH to control the inflammation and fibrosis of the liver. Since NAFLD and NASH are relatively new disease entities related to lifestyle, it is very important to make the general public aware about these diseases which are silent to begin with but can damage the liver in long run if not picked up early. Observing International NASH Day is a step in that direction and we plan to hold various education programmes for the general public on this day and the whole week informed Dr Duseja.
