Otherwise called “fatty liver disease” or “soda disease”, NAFLD (non alcoholic fatty liver disease or non-alcoholic fatty liver disease) is an accumulation of fat in the liver, mainly due to too rich a diet and too much sedentary lifestyle. According to a study conducted from the Constances cohort (Inserm), approximately 18% of the adult population would be affected, i.e. between 8 and 10 million people. If this excess fat in the liver does not generally evolve, it will create inflammation in 20% of cases, which can evolve into fibrosis, even cirrhosis or cancer.
This inflammatory form is called “non-alcoholic steatohepatitis” (NASH). It would concern up to 200,000 people in France. In the most severe cases, a liver transplant is necessary.
“The challenge is to detect patients with a severe form of fibrosis. We also need to educate general practitioners.explained Laurent Castera, from the hepatology department of the Beaujon hospital (AP-HP), in Clichy (Hauts-de-Seine), during a press briefing on the occasion of the Paris NASH Meeting, held in Paris on September 8 and 9. If this specialist reassures by saying that “most people who have fatty liver will not progress to a severe form, screening is important because these diseases progress slowly and give few symptoms”. This requires a blood test for transaminases (liver enzymes), an ultrasound or a Fibroscan, a non-invasive examination that measures the elasticity of the liver.
Improve cardiometabolic health
Type 2 diabetics are primarily concerned: nearly 60% of them are affected by steatosis, and the frequency of severe fibrosis is 7%. For the time being, learned societies recommend screening in diabetic patients, but also in obese people or people with a metabolic syndrome and, conversely, to look for type 2 diabetes in patients with hepatic steatosis.
As for the treatment, there is no medicine available. The cornerstone is based on lifestyle and dietary rules (physical activity, more balanced diet, less fat, less sugar), the challenge being to improve cardio-metabolic health.
About sixty molecules are being evaluated, with some three hundred clinical trials worldwide, announced Lawrence Serfaty, head of the hepatology department at the Hautepierre hospital in Strasbourg and president of this NASH Meeting conference.
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