INTERVIEW – NASH disease alarms specialists, who are seeing an increasing prevalence among their patients.
It is called “soda sickness”, or “fatty liver syndrome”. Non-alcoholic steatohepatitis or NASH (non-alcoholic steatohepatitis) is a form of cirrhosis, but without alcohol. The chronicler Pierre Ménès recently popularized it, by communicating about this disease from which he himself suffers. But it is very silently, insidiously, that it has established itself within the French population – and more generally, in the West.
In France, three to six million people suffer from this condition, linked to a diet that is too rich and an absence of physical activity. If public opinion is gradually becoming aware of the existence of Nash, in hepato-gastroenterology departments, the disease is alarming specialists. Prof. Victor de Lédinghen, head of the Hepato-Gastroenterology Department at Bordeaux University Hospital, shares his observations.
Is there really a silent Nash epidemic?
Prof. Victor de Lédinghen: Yes, it is indeed a reality and it is necessary that we speak about it, in particular thanks to people like Pierre Ménès. NASH is an increasingly frequent disease for one simple and good reason: more than one in two French people are now overweight, according to very recent figures provided by the Constance cohort. However, being overweight is one of the main causes of the disease.
At present, and for several years, this affection represents more than a third of my consultations and it does not stop increasing with the overweight. NASH is our daily life. It affects everyone, all patient profiles and does not spare children. This is consistent with the increase in overweight in the youngest.
Is there an underdiagnosis linked to a lack of knowledge of NASH?
Prof. Victor de Lédinghen: NASH is indeed very poorly diagnosed. People think that the only risk factors for developing liver disease are alcohol and viral hepatitis. However, today, alcohol remains the first factor, but NASH has taken second place, far ahead of viral hepatitis, which is on the decline.
The problem is, there are no symptoms like all liver disease, by the way. NASH starts off with fat in the liver, then as a reaction to that fat, it becomes inflamed in the liver – but there is still no pain. Then, the liver makes fibrosis, that is to say fibers. Finally, when there is a lot of fiber, we talk about cirrhosis. It is one of the most serious complications of NASH.
Are there other risk factors besides being overweight?
Prof. Victor de Lédinghen: Yes, there are several; this refers to what is called metabolic syndrome. It is the association of overweight, often with diabetes that goes with it, associated with hypertension and dyslipidemia, ie an excess of cholesterol and triglycerides.
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