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Fibrosis is the key to NASH progression, not the fat

Fibrosis is the key to NASH progression, not the fat

“It isn't fat but rather fibrosis that drives disease progression in people with advanced non-alcoholic steatohepatitis (NASH).”


NASH is one of the most prevalent liver diseases nowadays. NASH is related to non-alcoholic fatty liver disease (NAFLD) which is characterized by the buildup of fat in the liver. Although it is normal to have some fat in the liver, some people might develop inflammation because of this fat accumulation, this is called NASH.


Currently, there is no cure for NASH. The standard treatment recommendation for NASH patients targets at reducing fat. Patients are recommended to lose weight by leading a healthy lifestyle with balanced diet and adequate exercise.


Fat is not actually the problem


It’s natural to think eliminating the cause of disease (which is fat for NASH) would lead to recovery, but recently, a study found that the accumulated fat in the liver isn’t the issue to disease progression. Instead, measures of the degree of fibrosis – the Ishak score, enhanced liver fibrosis (ELF) score were associated with progression to cirrhosis for patients. 


The study was presented at the International Liver Congress, the annual meeting of the European Association for the Study of the Liver (EASL). Howard Thomas, the honorary president of the meeting stated that the study sheds new light on how advanced NASH changes over time and what drives those changes. 


“The bottom line was that it wasn't so much an issue of the fat itself, but of the stiffness of the liver”, Thomas said.


The study was conducted over a period of 96 weeks, with 477 NASH patients enrolled. In the study, histology was determined by liver biopsies taken at baseline (start of the study), week 48 (middle of the study), and week 96 (end of the study); quantifying fibrosis with an Ishak score and ELF score. Analysis showed that a higher ELF score at baseline and worsening over time predicted progression to cirrhosis. More importantly, it was found that no patients progressed if they had an improved Ishak score throughout the study.


Prevent and stop fibrosis


The liver is a unique organ that has the ability to recover itself. However when constant damage is done, e.g. chronic inflammation; fibrosis or scarring of the liver occurs as an attempt to limit tissue damage in response to chronic liver injury. Therefore, the key to preventing fibrosis is to stop inflammation, as inflammation is the major cause of liver damage. By stopping inflammation, fibrosis and progression of NASH can be halted or even reversed. This ensures that the risk of severe liver diseases is reduced in the long term.

  • * All research and clinical data should be used as reference purposes only, results may vary.
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