Nonalcoholic steatohepatitis, an inflammation of the liver associated with the accumulation of fat in the organ that is similar to a condition found in people who drink too much alcohol, is setting off alarm bells in Japan.
Some physicians refer to NASH, as it is known, as a new lifestyle-related disease. Difficult to spot because there are no symptoms, it is being detected with increasing frequency in people with certain medical conditions, including diabetes mellitus and obesity.
NASH will probably develop into cirrhosis of the liver and liver cancer, according to experts.
“When a drinker accumulates fat in his or her liver and develops a fatty liver, he or she may advance from alcoholic hepatitis to cirrhosis of the liver,” said Dr. Etsuko Hashimoto, an instructor of internal medicine at the Institute of Gastroenterology of Tokyo Women’s Medical University. “It was once considered common knowledge that a fatty liver in a nondrinker would not deteriorate. That no longer is the case.”
She said a fatty liver generates alcoholic hepatitis, which in some cases advances to cancer of the liver.
Hashimoto, who diagnoses and treats many NASH patients, said the disease is believed to be involved in a considerable number of cases of unknown causes of cirrhosis of the liver and liver cancer.
There are quite a few nondrinkers who accumulate fat in their body cells as a result of overeating or lack of exercise.
“It is necessary (for doctors) to find NASH patients hidden among those who have been diagnosed simply as having fatty livers, and give them appropriate treatment,” Hashimoto said.
A sure means currently available for diagnosing NASH is taking a liver biopsy.
But Hashimoto warned that this procedure is slightly dangerous and recommends it only for elderly people who have accumulated fat in their livers or when there is a demonstrated decline in liver functions.
NASH reportedly affects 2 percent to 3 percent of the population of the United States. Many of them are women aged around 50 and are overweight or have diabetes or high cholesterol.
It has also been reported that 70 percent of obese people are afflicted with NASH.
Progress from having a fatty liver to developing NASH is slow.
The survival ratio of people five years after being diagnosed with NASH is said to be about 70 percent.
No extensive study on NASH has been made in Japan, but information on 110 patients at Tokyo Women’s Medical University hospital shows that many female patients are in their 50s and 60s. Of the total number of male patients, 40 percent were less than 40 years old.
Hashimoto said the percentages may have something to do with increases in the number of younger obese people due to the Westernization of Japanese lifestyles.
She pointed out that the number of patients could rise dramatically when these people enter middle age.
It is still unclear what exactly causes NASH. But some doctors believe it may be closely related to insulin resistance.
There also have been reports that medicine for treating insulin resistance, some vitamins and ursodeoxycholic acid have eased NASH.
Even so, there is no established treatment for NASH.
Hashimoto said diet and exercise are the most important and effective ways to combat being overweight.
Many people have improved their physical condition by dieting and exercising during their hospitalization, she said, adding that Japanese are genetically vulnerable to becoming overweight.
Hashimoto emphasized that fighting obesity is an important matter.
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