NASH Risk Factors and Diagnosis

Approximately 22% of patients with diabetes have NASH⁵
Significant liver fibrosis has been observed in approximately 13% of patients with T2DM, and cirrhosis was found in 6% of these patients⁶
–In this study, the prevalence of steatosis, advanced fibrosis, and cirrhosis were evaluated in 133 adults >55 years of age using the NAFLD fibrosis score (NFS) and magnetic resonance imaging (MRI)⁶
Other metabolic disorders with an emerging association with NAFLD may include metabolic syndrome, dyslipidemia, polycystic ovarian syndrome, growth hormone deficiency, hypothyroidism, and hypogonadism⁷

NASH May Be Difficult to Diagnose¹

Liver biopsy may reveal signs of NASH, such as steatosis, hepatocellular ballooning, inflammation, and liver fibrosis¹⁰; however, patients may not feel symptomatic until late-stage disease, making it difficult to diagnose¹

Because biopsy only samples a small portion of the liver, there is a risk of incorrectly staging liver fibrosis if the sample is not representative of the whole liver¹¹
Less-invasive diagnostic options are also presently available¹¹
–Transient elastography may help to identify NASH or liver fibrosis¹¹
–Disease histology may not correlate with transaminases^3,12 and diagnosis requires hepatosteatosis assessed by imaging or histology³

With ongoing biomarker research, there may be less reliance on biopsy and histopathology in the future¹

References:

Sanyal AJ, Friedman SL, McCullough AJ, Dimick-Santos L; American Association for the Study of Liver Diseases; United States Food and Drug Administration. Challenges and opportunities in drug and biomarker development for nonalcoholic steatohepatitis: findings and recommendations from an American Association for the Study of Liver Diseases-U.S. Food and Drug Administration Joint Workshop. Hepatology. 2015;61(4):1392-1405.
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142(7):1592-1609.
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.
Younossi ZM, Stepanova M, Hallaji S, et al. Nonalcoholic fatty liver disease in lean individuals in the United States. Medicine (Baltimore). 2012;91(6):319-327.
Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140(1):124-131.
Arab JP, Barrera F, Gallego C, et al. High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients. Ann Hepatol. 2016;15(5):721-728.
Do A, Lim JK. Epidemiology of nonalcoholic fatty liver disease: a primer. Clin Liver Dis. 2016;7:106-108.
Wong RJ, Liu B, Bhuket T. Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross-sectional analysis of 2011-2014 National Health and Nutrition Examination Survey. Aliment Pharmacol Ther. 2017;46(10):974-980.
Maurice J, Manousou P. Non-alcoholic fatty liver disease. Clin Med (Lond). 2018;18(3):245-250.
Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014;5(3):211-218.
Schiff ER. Fibroscan (transient elastography) for the measurement of liver fibrosis. Adv Hepatol. 2012;8(9):605-607.
Ofosu A, Ramai D, Reddy M. Non-alcoholic fatty liver disease: controlling an emerging epidemic, challenges, and future directions. Ann Gastroenterol. 2018;31(3):288-295.

Liver biopsy may reveal signs of NASH, such as steatosis, hepatocellular ballooning, inflammation, and liver fibrosis10; however, patients may not feel symptomatic until late-stage disease, making it difficult to diagnose1

Liver biopsy may reveal signs of NASH, such as steatosis, hepatocellular ballooning, inflammation, and liver fibrosis¹⁰; however, patients may not feel symptomatic until late-stage disease, making it difficult to diagnose¹