Monday, June 18, 2018

Hepatitis C Weekend Video: NASH What Is It?

Weekend Video
Welcome, this weekend we start with a few articles on a "silent" but potentially serious condition called nonalcoholic fatty liver disease (NAFLD), followed by a new seven part video series on nonalcoholic steatohepatitis (NASH), the most severe form of NAFLD.

What Is NAFLD? 
Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis), learn more, here

While the burden of liver disease from HCV decreases - lowering the number of patients waiting or undergoing liver transplant - the waitlist for nonalcoholic steatohepatitis (NASH) has increased. In addition, NASH is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates.

Research Articles:

The Effects of Physical Exercise on Fatty Liver Disease
For people with HCV (without fatty liver disease) research shows weight reduction leads to a decrease in steatosis and liver enzymes, and also to an improvement in fibrosis, despite persistence of the virus. Previous research also indicates HCV patients who participated in a diet and exercise program lowered their grade of steatosis and remarkably their fibrosis score, according to a study published in Nutrition 2013. Whether you have fatty liver disease, HCV or both read; The Effects of Physical Exercise on Fatty Liver Disease, published in Gene Expression 2018, to learn more about the effects of exercise on NAFLD and NASH.

NAFLD & Type 2 Diabetes 
Published in World J Gastroenterology 2016
"NAFLD is most prominently linked to chronic kidney disease, mellitus type 2 and cardiovascular disease, as well as a number of other severe chronic diseases. These findings demonstrate that NAFLD ranks amongst the most serious public health problems of our time."
Also noted in the article, prevalence of Nonalcoholic Steatohepatitis (NASH) in people who are obese and have type 2 diabetes may be as high as 40%, whereas it is less than 5% in people without type 2 diabetes.
Read the article, here.

NAFLD Is a Growing Problem
NAFLD is the most common form of liver disease in Western countries.[4] Men are affected more than women.[5] Persons with a "high body mass index in late adolescence" are at risk for advanced liver disease and hepatocellular carcinoma (HCC)..

The term "NAFLD" describes both hepatic steatosis with hepatocyte fat accumulation in a liver lacking inflammation, whereas NASH is associated with fat accumulation, hepatic inflammation, and hepatocyte injury with or without fibrosis or cirrhosis..

Not every patient with NAFLD is obese. Seven percent of lean patients have NAFLD,[18] especially in the presence of metabolic syndrome.[19] Lean patients with fatty liver also are observed among those with polycystic ovary syndrome.[20] Compared with lean patients, obese patients with NAFLD are more likely to have greater fibrosis and a worse clinical prognosis.[21] Nonobese patients with NAFLD have a lower prevalence of hypertension, diabetes mellitus, metabolic syndrome, and steatohepatitis than obese patients[22] but remain at risk for development of advanced liver disease[23] and associated metabolic abnormalities and cardiovascular disease.[22] 
Continue reading @ Medscape
Free registration may be required. 

The International Liver Congress 2017
NASH: It's Fibrosis, Not Fat, that Matters
Analysis sheds new light on what drives disease progression
AMSTERDAM -- It isn't fat but rather fibrosis that drives disease progression in people with advanced non-alcoholic steatohepatitis (NASH), a researcher said here
Continue reading....
Free registration may be required. 

HCV & Steatosis
Given the development of steatosis is well-known in people with HCV, the following articles may be of interest to you, lets start with an article published in Clinical Liver Disease 2017; Metabolic Manifestations of Hepatitis C Virus
Out of excessive consumption, steatosis should be classified into 2 types according to hepatitis C virus (HCV) genotypes: metabolic steatosis, which is associated with features of metabolic syndrome and insulin resistance in patients infected with nongenotype 3, and viral steatosis, which is correlated with viral load and hyperlipemia in patients infected with genotype 3.
Download the article, here

Published in the 2016 issue of International Journal of Molecular Sciences; NAFLD and NASH in HCV Infection: Prevalence and Significance in Hepatic and Extrahepatic Manifestations, researchers investigated factors associated with NAFLD/NASH in chronic HCV, and the role of “viral steatosis” associated with HCV genotype 3 infection. 

Of Interest
HCV Treatment Genotype 3
The International Liver Congress, 2018
Treatment for hepatitis C genotype 3 infection can be completed in 8 weeks in people without cirrhosis, three real-world studies presented at the conference confirmed. 

Fatty liver is very common in hepatitis C virus (HCV) patients post-SVR 
According to data published March 21, 2018 in the online journal World J Gastroenterology, evidence of steatosis was reported to be found in close to half of patients who achieve a sustained virologic response after treating with direct-acting antivirals. 
Core tip: This is the first prospective study to assess the prevalence of fatty liver in hepatitis C patients who have achieved a sustained virological response with direct-acting antivirals. The study’s findings that fatty liver is present in 47.5% of these patients and that some steatotic patients have clinically significant fibrosis despite normal liver enzymes should raise awareness of the post-sustained virological response (SVR) prevalence of fatty liver and the importance of post-SVR assessment of steatosis and fibrosis and long-term follow up with these patients.
Full-text, here

NASH Leading Cause of Liver Transplant in Women
"NASH is currently the second leading cause for LT waitlist registration/liver transplantation overall, and in females, the leading cause. Given the rate of increase, NASH will likely rise to become the leading indication for LT in males as well" according to a June 2018 study published in The American Journal of Gastroenterology.

7 sequences about NASH
On June 12, 2018, the 1st International NASH Day was launched by The NASH Education Program, along with their seven part educational program to help patients understand this serious liver disease. Listen to expert interviews, learn about symptoms, non-invasive tests used to measure liver inflammation and fibrosis, and hear from patients struggling with the disease.

NASH What Is It?
The video is the first part of a WEBTV of 7 sequences about NASH
Published June 12, 2018
Speakers: Pr Stephen Harrison, Pr Sven Francque
In this first TV show you will understand – thanks to a worldwide overview – how little-known NASH is and why this situation has to be changed. Liver experts will go over non-alcoholic steatohepatitis (NASH) details, its mechanisms, consequences, symptoms and stigmas. These will also be highlighted by a patient testimony at the end of the video footage.

Part One

SUBTITLES ARE AVAILABLE IN 6 LANGUAGES, using settings of the video (Gear Icon at the bottom right of the video): English - Spanish - French - Italian - German - Portugese

Full Playlist:
PART 1 NASH What Is It?
In this first TV show you will understand – thanks to a worldwide overview – how little-known NASH is and why this situation has to be changed. Liver experts will go over non-alcoholic steatohepatitis (NASH) details, its mechanisms, consequences, symptoms and stigmas. These will also be highlighted by a patient testimony at the end of the video footage.

PART 2 NASH How Common Is It?
In this second TV show, you will understand how widespread NASH is, with prevalence figures and future projections exposed. During the interviews, livers experts will bring up information on NASH frequency, genetic predispositions, how children are now subject to this preventable disease, and which populations are most commonly affected.

PART 3 NASH: Who is at risk?
In this third TV show, you will discover that NASH is much more than just a liver disease and that it is related to metabolic disorders – such as diabetes and obesity – and closely linked to modern lifestyles: unhealthy diets and lack of physicial activity. The diverse speaker panel will explain why some people are more at risk than others and how much exercise can help, if sufficient and sustained. Lastly, the video will follow patients associations in their mobilizations against NASH.

PART 4 NASH: Getting Diagnosed
In this fourth TV show, you will discover how much of challenge NASH diagnosis is – mainly because NASH is a silent disease (no symptoms) which makes it difficult to diagnose – and how current procedures can be a bottleneck in the patient journey. Liver experts will explain the current invasive and non-invasive diagnostic techniques used when NASH is suspected, as well as latest research in novel diagnostic tools and what the future holds in terms of diagnosis.

PART 5 NASH: Disease evolution and consequences
In this fifth TV show, you will learn more about the consequences of non-alcoholic steatohepatitis in the liver, but also in the rest of the body, with associated conditions. A French sports journalist will share his testimony as a NASH patient that overcame a liver transplant and a kidney as the last resort to survive, and a representative from The Liver Forum will explain how experts work to research the best patient clinical management solutions. In the end, you will know more about the consequences on health, the consequences on the economy, stigmas, lessons learned and the dire need for awareness.

PART 6 NASH: Patient care and clinical management
In this sixth video, you will discover how much of a challenge patient management is, and especially, how to answer this burning question: “how can we care for patients in the absence of treatment?” – Today, on top of the lifestyle change (weight loss and exercise) ongoing research on therapeutic solutions paves the way for a better patient care. Moreover, you’ll discover how physicians are all working hand in hand to cover all the aspects of this multi-faceted disease. Finally, you will have the opportunity to hear the American Liver Foundation’s CEO’s perspectives on NASH.

PART 7 NASH: What perspectives?
In this seventh video, you will learn more about the next key challenges in the field of NASH, and about the crucial need for awareness and for public policy. Experts will give some forecast about NASH, ongoing research and the shed light on future management solutions You will get insights on the economic burden of NASH and the need for all stakeholders to be involved in NASH awareness. To conclude these seven sequences, there will be a special focus on how street art can help increase awareness and what we can hope for in the future.

Non-alcoholic fatty liver disease: risks, prevention, and more
June 11, 2018
Lauren Phinney
Doctor Rohit Loomba appeared on KUSI News in San Diego to discuss Non-alcoholic fatty liver disease and how to prevent it. 
Watch his informative interview here.

The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases
A recent publication from the American Association for the Study of Liver Diseases (AASLD) provides guidance for the evaluation and management of patients with NAFLD.
This guidance provides a data‐supported approach to the diagnostic, therapeutic, and preventive aspects of nonalcoholic fatty liver disease (NAFLD) care. A “Guidance” document is different from a “Guideline.” Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations, Assessment Development, and Evaluation system. A guidance document is developed by a panel of experts in the topic, and guidance statements, not recommendations, are put forward to help clinicians understand and implement the most recent evidence. 

On This Blog 

Maybe this weekend you might think about eating right or even start walking, two key elements for keeping your liver healthy. 

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