NASH and Advanced Fibrosis: Risk Factors

Viviana Figueroa Diaz, MD, reviews risk factors commonly associated with nonalcoholic steatohepatitis and advanced fibrosis caused by nonalcoholic steatohepatitis, including genetic predisposition and obesity.

Transcript

Viviana Figueroa Diaz, MD: Advanced fibrosis in NASH [nonalcoholic steatohepatitis] is caused by the development and the deposition of fat in the liver related to the risk factors for NASH, including obesity, diabetes, high cholesterol, and sedentary lifestyle. That fat accumulation in the liver causes the liver to be inflamed. It recruits cells to fight off the fat, if you want to say that.

In the meantime, while it’s developing inflammation, it develops scar tissue. It’s like leaving scar tissue behind, exactly like when we have an injury in our skin and we develop scar tissue—the same type of cells and depositions. The problem is, more scar tissue deposited in the liver can cause you to develop more and more fibrosis, or advanced fibrosis, which can lead to cirrhosis.

Besides the risk factors that I already mentioned for NASH and the development of fatty liver and advanced fibrosis, we have to consider genetic factors that can play a role in the development of NASH. In certain populations and ethnicities, including the Latin population, we have identified that there is more common genetic predisposition to developing NASH.

Other populations that we’re seeing right now: because of early obesity, children are developing early diabetes, or what we call semimetabolic syndrome. That can predispose them for fatty liver. Actually, there are some statistics showing that up to 12% of at least Latin children have fatty liver nowadays.

In the United States there are different numbers, but let’s say there is up to 40% fatty liver disease prevalence in the United States. Yes, it’s leading here, but it’s catching up in other places as well, including Europe.