The Obese Liver

Are fatty livers the next trendy epidemic to hit our shores on top of an already burgeoning obesity epidemic and other related problems?

Most people who think of liver disease think of cancer or alcohol-induced damage. But in the US most liver transplants in some centres are now for NASH.

So what is NASH and why is it forecasted to be a considerable health problem in Ireland and the UK?

The full medical name for NASH is non-alcoholic steatohepatitis and it is not associated with drinking too much alcohol. Symptoms of NASH, or fatty liver disease as it is also called, are often hidden or silent. The first step is the development of a fatty liver. The liver becomes inflamed and damaged when NASH is present.

The figures for NASH in Ireland and the UK are likely to be low, but in the US it is already estimated that it occurs in 2-4% of the general population and some evidence of excess fat in the liver (fatty liver) in 10-20%.

Fatty liver disease is a global epidemic closely linked to the metabolic syndrome cluster of symptoms. It is closely linked in particular to the dramatic increase in global obesity. So this explains why it is currently higher in the US than in Europe.

NASH is a relatively rare entity in Ireland and the UK, but with the increase in obesity seen, it will increase.

No therapies are currently used specifically for NASH, but strategies to reduce weight and avoiding alcohol, as drinking may exacerbate symptoms, are recommended.

Treatment of fatty livers can require transplantation if the damage becomes extensive with scarring of the liver and limiting function.

The decision to transplant depends on the severity of debility and patient eligibility. Selection is complicated by the fact NASH patients are usually obese with an elevated BMI, and usually also have kidney damage, may have diabetes mellitus and high blood pressure.

Conor Caffrey is a writer on science and medicine.


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