This International NASH Day is an opportunity to remember how long and punctuated by complex steps establishing the diagnosis of this silent disease can be. Knowing them can help the patient better understand what they are going through.
- NASH is associated with the metabolic syndrome and is characterized by an accumulation of fat in the liver
- It is a silent disease whose diagnosis is based on several complex steps
- Obesity and type 2 diabetes are major risk factors for NASH
NASH, for Non Alcoholic Steato Hepatitisor non-alcoholic steatohepatitis in French, is more commonly called non-alcoholic fatty liver disease (or soda disease). Plague of modern times, NASH is the most common chronic liver disease in Western populations, in particular because of the growing prevalence of obesity and type 2 diabetes.
Men more affected than women
Pathology associated with the metabolic syndrome (abdominal obesity, cholesterol, diabetes, hypertension, etc.), NASH is characterized by an accumulation of fat in the liver, which occurs outside of any excessive alcohol consumption. Without treatment, it can lead to cirrhosis or liver cancer. In 2019, in France, according to a study based on the CONSTANCES cohort, 16.7% of the population included had NASH: 24.6% of men and 10.1% of women. The number of cases increases with age and reaches 36.2% in men aged 68-78. Finally, it concerns 79.7% of obese people and 63% of diabetics.
Most people with NASH are asymptomatic, making it difficult to diagnostic. Nevertheless, it happens sometimes they feel slight fatigue, malaise or abdominal discomfort. This is Why this disease is sought in people suffering from type 2 diabetes, obesity, sleep apnea, metabolic syndrome, chronically high levels of liver enzymes or even hyperferritinemia.
Alcohol consumption, BMI, blood pressure arterial
To establish his diagnosis, the attending physician will ask his patient about his alcohol consumption, which will be considered low when it does not exceed 20 g/day for women and 30 g/day for men. He will also make sure that his patient is not taking drugs conducive to fatty liver disease, measure their BMI and blood pressure. The waist circumference is also an indicator that he will take into account, excess fat accumulated in the abdomen being a risk factor. The waist circumference will be considered high if it exceeds 80 cm for a woman and 94 cm for a man.
A blood test will establish the patient’s blood formula to determine “the number of blood cells (red blood cells, white blood cells and platelets) and their characteristics”explains the Health Insurance website Ameli. Ie dosage of glycemia (blood sugar level), that of liver enzymes, a lipid profile “to measure total cholesterol, HDL-cholesterol, LDL-cholesterol”an insulin resistance test and finally an iron test can also help establish a diagnosis.
To confirm this, the doctor may prescribe an abdominal ultrasound. to observe the structure of the liver and look for possible fibrosis, as well as a liver biopsy when necessary. By diagnosing NASH, the doctor will then look for possible traces of type 2 diabetes, cardiovascular disease, sleep apnea, osteoporosis, polycystic ovary syndrome or even hyperthyroidism.
Knowing that NASH is a silent disease and knowing the complexity of these diagnostic steps can facilitate early management.
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