NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

NON-ALCOHOLIC FATTY LIVER DISEASE

(NAFLD)

& NON-ALCOHOLIC STEATOHEPATITIS

(NASH)

ADDRESSING A GROWING SILENT

EPIDEMIC

Prevalence (%)

PREVALENCE OF NAFLD/NASH

USA Prevalence in Middle Age Patients

San Antonio, Texas (Williams et al., Gastroenterology

2011; 140:124-31)

Dallas Heart Study Prevalence Numbers (Browning et al., Hepatology 2004;40:1387-95)

60

58.3%

46%

40

30%

20

45%

44.6% 33%

35.1% 24%

12.2%

29.9%

0

NAFLD Overall

NAFLD Hispanic

NAFLD Caucasian

NAFLD African American

NASH Overall

NASH among diagnosed NAFLD

Worldwide prevalence of NAFLD: 20-30%

13-44% in Middle Eastern countries Approx. 20% in Asian countries Approx. 30% in European countries NASH worldwide prevalence unknown (estimate from U.S. study: 6-8%)

NAFLD/NASH Prevalence among Patients with diabetes

NAFLD 80-90%

NASH 56-69%

ADVANCED FIBROSIS

37-50%

NAFLD/NASH Prevalence among obese Patients

Prevalence among bariatric surgery patients

NAFLD 70-90%

NASH 25-30%

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

ISOLATED STEATOSIS

NON-NASH NAFLD

CVD

NASH WITH MILD FIBROSIS

NASH WITH ADVANCED FIBROSIS

CIRRHOSIS

HEPATOCELLULAR CARCINOMA

NAFLD is an umbrella term that encompasses the spectrum of fatty liver disease, from isolated steatosis

to cirrhosis and liver cancer with underlying CVD risk.

NATURAL HISTORY OF NAFLD

~70-75%

Isolated Fatty Liver

Fatty Liver with Mild inflammation

1- None to very minimal progression to fibrosis 2- No risk of death compared with the general population

Possible sampling variability with some risk of progression

NAFLD

~20-25%

~11% over 15 years, but significant variability

NASH

1- risk of death compared with general population 1- Cardiovascular 2- Malignancy 3- Liver-related

2- NASH with fibrosis portends worse prognosis 1- Fibrosis progression a/w DM, severe IR, weight gain>5kg, rising ALT, AST

NASH Cirrhosis

HCC ~7.2% over 6.5 years

Decompensation ~19-45% over 7-10 years

Modified from Torres DM et al. Features, diagnosis, and treatment of NAFLD. Clin Gastro Hepatol 2012;10:837-858

Progression of isolated steatosis to cirrhosis is very rare Fatty liver with inflammation but not NASH may progress but at a slower rate than NASH NASH with fibrosis is at greater risk for disease progression Patients with NASH and metabolic syndrome are also an enriched population for disease progression NAFLD/NASH is now the second leading cause for liver transplantation in the U.S.

Hierarchy of Histologic Features

Associated with disease progression and mortality

A

INCREASED MORTALITY

OR LT

B

INCREASED RISK OF

LIVER-RELATED EVENTS

C

Predictors

Fibrosis, stage 1 Fibrosis, stage 2 Fibrosis, stage 3 Fibrosis, stage 4 Age (years) Diabetes (yes) Smoking

Never Former Current Statins use (yes)

Hazard Ratio

95% Cl of HR

1.18, 2.81 1.20, 3.03 1.16, 3.12 3.35, 12.04 1.05, 1.08 1.11, 2.30

P value

.007 .007 .01 ................
................

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