International Nash Day 2022: How to fight Non-alcoholic steatohepatitis?
NASH Day: how to fight Non-Alcoholic SteatoHepatitis?
On International NASH Day, June 9, 2022, IHU ICAN looks back at ways to fight this liver disease that affects 25% of the adult population worldwide.
Also called “fatty liver disease” or “soda disease”, the Non-Alcoholic SteatoHepatitis (NASH) is a chronic disease caused by accumulation of intrahepatic fat in the liver (steatosis), associated with metabolic risk factors (obesity, type 2 diabetes…), but not linked to excessive alcohol consumption.
NASH: a disease in constant progression
The number of individuals with metabolic steatosis is increasing rapidly and will continue to do so in the coming years, especially with the increase intype 2 diabetes and obesity worldwide.
- 18.2% of the adult population in France affected (25% worldwide, 32% in the US)
- 7,000 deaths per year in France(118,000 in Europe, 104,000 in the United States)
- 3,445,000 new cases in Europe in 2016
- Average age of onset:52 years(mainly in men)
Source: Serfaty Gastroenterology 2020, CONSTANCES cohort
What are the causes of NASH?
One of the main causes of the development of NASH is the insulin resistance of an individual, associated with metabolic risk factors such as :
- Severe obesity,
- Type 2 diabetes(more than 70% of diabetic patients are affected by steatosis),
- High blood pressure,
- Sleep apnea,
- Dyslipidemia,
- Aging,
- Or genetic and epigenetic factors(cases of familial aggregation in relation to environmental and epigenetic factors).
Disease considered silent, NASH is often diagnosed unexpectedly, sometimes at advanced stages: fibrosis, cirrhosis, hepatocellular carcinoma…
How to prevent NASH?
There is no effective treatmentto cure a patient with NASH. Research and innovation are therefore essential to improve patient care.
However, certain hygienic and dietary measures are strongly recommended for patients at any stage of severity of hepatic steatosis:
- Change in diet with an adapted diet, limitation of alcohol consumption, diet,
- Fight against sedentary lifestyle,with an increase in physical exercise and sports,
- Weight control,
- Diabetes control.
These modifications are essential to promote the regression of the disease (steatosis, NASH or fibrosis) and to slow down the evolution towards cirrhosis and its complications(hepatic cancer, decompensation of cirrhosis).
In cases where dietary measures are not sufficient to slow the progression of NASH, bariatric surgery may be considered:
- For obese patients without advanced fibrosis, it allows a significant improvement of the liver damage with a return to a normal liver in a considerable proportion of cases.
- For patients with advanced fibrosis (≥ F3) or cirrhosis, however, the results are moderate.
NASH: how to improve patient management?
NASH has a significant impact on public health expenditures, with direct and indirect costs associated with the disease that are significant to health systems. Indeed, this disease is a multifactorial pathology that requires a multidisciplinary management.
To answer this problem, theIHU ICANcontributed in 2019 to the implementation of the NASH clinic with AP-HP (Public Hospitals of Paris) which is today the 1st hospital structure for diagnosis and multidisciplinary care of patients with metabolic steatosis in France.
- Over 300 patientscaredfor since its inception between 2019,
- An innovative, multidisciplinary and personalized care program,
- A unified and fluid circuit, in a single location at the Pitié-Salpêtrière Hospital (Paris),
- A dedicated team: hepatologist, radiologist, nutritionists, dietician, therapeutic education and sports educators.
How to act in the fight against NASH?
Donations are essential to support the excellence of French research on cardiometabolic diseases and to take action on this major public health issue. Find out how your donations are used.
- You can choose to support medical research against non-alcoholic fatty liver disease alongside the ICAN IHU by making a donation to the projects developed by the NASH clinic. Contact Francine Trocméby e-mail at trocme@ihuican.org or by phone at 01 88 40 64 05.
You can also support all the activities of the IHU ICAN, which fights on a daily basis against other cardiometabolic diseases (obesity, diabetes, heart and vessel diseases, etc.).
Clinique NASH, an innovative care pathway unique in France
Clinique NASH, an innovative care pathway unique in France
The NASH clinic was set up in 2019 by a multidisciplinary team from the AP-HP with the support of the IHU-ICAN in order to optimize the diagnosis and management of people with fatty liver disease; better control their disease and slow down or even curb its progression towards serious forms (cirrhosis, liver cancer) requiring major interventions such as liver transplantation.
NASH (Non-Alcoholic Fatty Liver Disease) is aliver disease caused by an accumulation of fat of metabolic origin independent of alcohol consumption or viral hepatitis. It is very often the consequence of a lifestyle that is too sedentary associated with a diet that is too rich in fats and sugars.
It concerns between 400,000 and 500,000 people in France per year, i.e. 25% of the general adult population . People with NASH are often asymptomatic and have a higher risk of developing cardiovascular disease, high blood pressure, or diabetes. Conversely, these comorbidities, particularly obesity and diabetes, are risk factors for the progression of liver damage to the most severe forms (cirrhosis and liver cancer).
The NASH clinic: the first hospital structure for the multidisciplinary care of patients with metabolic steatosis in France
Also, the AP-HP and ICAN teams have created the NASH clinic to offer patients a care pathway innovative, multidisciplinary and personalized. This course aims toanticipate and intercept the complications of NASH (early atherosclerosis, arterial hypertension, diabetes, etc.) and offer personalized care to each patient, taking into account their clinical phenotype, personal history and environment to ensure the best possible compliance with medical recommendations. The IHU-ICAN has made available dedicated human resources (1 doctor and 1 nurse) as well as its clinical investigation center, and has offered the conditions necessary for the construction of this course thanks to its transversal and multidisciplinary approach to diseases. cardiometabolism and nutrition.
Today, more than 200 patients have already benefited from it. The patient journey is simplified and unified within the framework of day hospitalization in the hepato-gastroenterology and nutrition departments of the Pitié-Salpêtrière hospital. Various medical specialists (hepatologist, radiologist, cardiologist, dietitian, diabetologist, surgeon, etc.) are mobilized to carry out the examinations necessary to establish a phenotype and a precise diagnosis with an assessment of hepatic and cardiometabolic risk. For better patient support, the circuit also offers a therapeutic education consultation, essential for better adherence to the proposed therapeutic programs.
