VCU study results reveal real burden of hidden fatty liver disease pandemic – VCU News
A national longitudinal study led by Arun Sanyal, a researcher at the Commonwealth of Virginia University, shows that people with advanced liver scars caused by obesity, diabetes and related disorders die from liver disease.
Published in the New England Journal of Medicine, the research brings new urgency to testing for liver disease, especially in populations with type 2 diabetes, and creates a roadmap for future treatments for fatty liver disease nonalcoholic – treatments that might prevent the need for liver transplants for people with advanced disease.
“This is the first clear picture of the actual rates of results in people with [nonalcoholic fatty liver disease]Said Sanyal, liver disease specialist at VCU Health. “And the study gives teeth to recent guidelines from the American Diabetes Association to start screening for liver disease – to make screening more common.”
Many people believe that only excessive alcohol consumption causes liver disease. However, a quarter of adults worldwide suffer from non-alcoholic fatty liver disease, a condition in which excess fat is stored in the liver and is more closely linked to obesity and diabetes than to alcohol consumption. . Most people don’t know they have non-alcoholic fatty liver disease or that they are at high risk.
If left untreated, the disease can progress to an advanced form, where the buildup of fat in the liver can cause inflammation, scarring (known as fibrosis), and full-blown cirrhosis that leaves the permanently damaged liver. Patients are usually diagnosed when the disease is advanced and a transplant is the only option. The number of liver transplants in the United States has increased every year since 2012, straining the supply.
For this study, researchers followed more than 1,700 patients for a median of four years, some of them for 10 years, to assess their results.
They found that patients with advanced fibrosis are more likely to die, especially after gastrointestinal bleeding or fluid buildup in the abdomen and progressive deterioration in brain function due to liver disease. The results confirmed that people with badly scarred livers are at the highest risk of death.
The Non-Alcoholic Steatohepatitis Clinical Research Network (NASH-CRN) was funded by the NIH National Institute of Diabetes and Digestive and Kidney Diseases to improve understanding and treatment of this difficult disease by closely monitoring a great group of people, ”said Averell Sherker, MD, NIDDK program director for NASH-CRN. “This study demonstrates the enormous value of careful, long-term follow-up in gaining knowledge about the progression of fatty liver disease and using that knowledge to predict the severity of a patient’s disease.”
The results have implications for both the identification and treatment of non-alcoholic fatty liver disease.
“Historically, many primary care physicians and diabetes specialists have believed that because the roots of the disease are in insulin resistance, then if we are treating diabetes we have already taken care of the problem.” said Sanyal, who is also a teacher. in the Division of Gastroenterology, Hepatology and Nutrition of the Department of Internal Medicine of the VCU School of Medicine. “And what it shows is that, even in a particularly obese diabetic population, those with advanced fibrosis die from liver disease. Just treating diabetes doesn’t get the job done.
Drugs that stop or reverse the progression of fibrosis could save significant numbers of lives. No drug is approved by the Food and Drug Administration to treat non-alcoholic fatty liver disease or its more advanced version, non-alcoholic steatohepatitis.
In the United States, it is estimated that there are 2 million people living with non-alcoholic steatohepatitis and 1.3 million living with stages three and four of fibrosis. Based on the death rates seen in Sanyal’s study, around 40,000 of these people die each year.
Sanyal has been studying these forms of liver disease since the mid-1990s, when he noticed more patients had fatty liver disease and no history of alcohol use disorder.
“It was like a black box with no factual guidance on how to find it, assess it and manage it. We didn’t know anything about it, ”he said. “And I was struck one day that most of the patients we saw had diabetes and high blood pressure, and that could be related to insulin resistance.”
Much of the foundational work of this study and many studies of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis have their roots in VCU and in the work of its clinical researchers. Sanyal is a leader at the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, which has funded and supported his and others’ research.
“With the help of colleagues at the Wright Center, I practiced making insulin tweezers and studied insulin resistance, which was not common in the liver,” Sanyal said. . “It was something that fell into the realm of diabetes and endocrinology. But we did the original study showing the link between fatty liver disease and insulin resistance, and the field has exploded.
Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are still recently discovered diseases, Sanyal added. “There are still huge gaps in knowledge and awareness, both within the physician community and the public. “
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, and several researchers involved are supported by National Center for Advancing Translational Science awards at the NIH.
“Dr. Sanyal and his team are remarkably productive, and this is the fourth article on [nonalcoholic fatty liver disease] and [nonalcoholic steatohepatitis] published by Sanyal in the New England Journal of Medicine this year – and one of many leading journals, ”said Peter Buckley, MD, Dean of VCU School of Medicine.
Sanyal has continued his work on liver disease while leading several trials for COVID-19 treatments since March 2020.
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