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NASH: Progression of a potentially life-threatening disease
Non-alcoholic fatty liver disease (NAFLD) is a collective term used to describe a group of conditions where there is an abnormal accumulation of fat in the liver in those who drink little to no alcohol. This may range from a non-serious condition called fatty liver to a potentially serious condition called non-alcoholic steatohepatitis or NASH.
The prevalence of NAFLD in the United States is reported to be between 10% and 30%, and the pooled overall global prevalence of NAFLD diagnosed by imaging was estimated to be greater than 25%. However, the exact prevalence of NAFLD and NASH in an adult population remains difficult to assess due to the lack of a cost-effective and widely available, minimally-invasive diagnostic test, and to the absence of specific symptoms before end-stages.
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The liver is the largest solid organ in the body and it performs many essential functions, such as nutrient metabolism, protein synthesis, bile production, and glycogen storage. A healthy liver is blood-red with a smooth surface and contains 5% (or less) fat.
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Fatty liver, or non-alcoholic hepatic steatosis, is observed in individuals who chronically consume excess calories and/or have a sedentary lifestyle, in the absence of significant alcohol consumption. Excess calories are stored in liver cells as lipids, resulting in a liver with fat content above 5% and a pale yellow color.
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After enough excess fat has accumulated in the liver, chronic inflammation and cell death (ballooning) result in NASH. At this stage, patients have a higher risk of death from cardiovascular disease.
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Chronic and continuous cell damage and ballooning result in the formation of fibrous scar tissue (fibrosis). Eventually, excessive scar formation will result in loss of liver function, a state known as cirrhosis or stage 4 fibrosis.
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Patients with NASH-related cirrhosis are at higher risk of end-stage liver diseases, such as loss of liver function (decompensation), liver failure, and hepatocellular carcinoma (liver cancer). They are also at higher risk of death from cardiovascular disease and non-liver cancer.