Systematically Decoding NASH Step by Step

NAFLD encompasses a wide spectrum of disease including hepatic steatosis, inflammation and fibrosis. NASH is a progressive form of NAFLD. The prevalence of NAFLD and NASH correlates with the global rise in obesity and metabolic syndrome, affecting both adults and children. NAFLD is rising to be one of the major causes of liver disease worldwide with an approximate global incidence of 24%. The association between NAFLD and Type 2 Diabetes has been well documented, but other endocrine disorders like PCOS, hypothyroidism, are known in clinical practice to be associated with NAFLD. The 20% rule says that 20% of individuals with NASH with advanced NFS (F3) proceed to have cirrhosis over a 2-year time frame. The most effective intervention to manage NAFLD remains to be lifestyle modifications, with sustained weight loss. Bariatric surgery is mostly indicated for morbidly obese patients, as it helps reduce the weight of the patient. Metformin and Litaglutide are pharmacological options to control diabetes, Obeticholic acid has anti-fibrotic effects, while Gemfibrozil and Clofibrate control the level of triglycerides and cholesterol in the blood thereby controlling the development of NASH. Thiazolidinediones (TZD) is an insulin sensitiser and Resmetriom helps by reducing the formation of fat in liver, which is helpful in treating NASH. Treatment with berry juice decreased apoptosis rates in NASH models. Inspite of several challenges, liver transplantation is the standard treatment option for NASH. The risk of developing steatosis reaches 100% at 5 years after liver transplantation.