Nonalcoholic Steatohepatitis

Happened upon a story in The Sunday Times today (Scottish Edition) regarding a liver disease known as NASH. Apparently it's becoming a bit of an epidemic in Scotland down to the crap diet and being a fat b*stard. As I've now lived in Scotland, getting on for 15 years, it may be that I've also become a victim (though I've never had a deep fried Mars Bar in my chuff, but I am a fat b*stard). Story copied below as I can't link to it directly. Lots of good info on the disease can be found at the link above.

Junk food diet blamed for record cases of liver disease
Sue Leonard

SCOTLAND's junk food diet is fuelling a dramatic rise in liver disease, one of the country's leading transplant specialists has warned.

Professor Peter Hayes, head of Edinburgh Royal Infirmary's liver transplant unit, is treating 100 patients a year who are suffering from obesity related liver disease.

Since 2003 the unit has carried out four transplants on patients with cirrhosis of the liver as a direct result of their diet. The disease is normally associated with alcohol abuse and is also affecting teenagers, according to Hayes.

The rise in cases of cirrhosis and other forms of liver diseases mirrors soaring obesity rates in Scotland. Almost two-thirds of Scottish adults are overweight and more than one in five are classified as clinically obese.

Until now obesity has been linked with complications such as diabetes, heart disease and forms of cancer.

One of the commonest reasons for referral to our unit is because of abnormal liver tests due to obesity, said Hayes. We are talking about hundreds of people. They have some problem in the liver, we believe because of their obesity. I have seen somebody in their late teens.

Hayes added that because liver disease is so closely associated with alcohol abuse, it is likely that the condition is going undetected in many obese people.

We are seeing a bit of an epidemic of abnormal tests in obese people, he said. We are probably seeing the tip of the iceberg. I will quite often see two new people in the clinic weekly.

We are seeing more people having transplants because of obesity related liver disease. It is a terrible thing that people have to have a transplant because they did not keep their eye on their weight.

Abnormal liver tests in overweight patients are usually a sign of fatty liver, where fat makes up at least 10% of the organ.

Although the condition can be reversed by losing weight, it can develop into non-alcoholic steatohepatitis (NASH), an inflammation of the organ which is common in between 20% and 40% of people who are grossly overweight.

NASH can also lead to cancer or cirrhosis, scarring of the liver and the loss of liver cells that prevent the organ from working normally. Only about a third of patients with the disease survive five years after diagnosis.

NASH is preventable but not when you have cirrhosis, said Hayes. It is not well recognised and there is little research into it. Almost nobody would think that being overweight can be a sign of liver disease. I have people referred for transplant. They come in with end stage liver disease. A significant number will die.

Dr Stuart Hislop, a gastroenterologist at Royal Alexandra hospital in Paisley, said doctors had previously thought that fatty liver was not harmful to patients but there was now evidence that some older patients with diabetes were developing cirrhosis.

Phil Hanlon, professor of public health at Glasgow University, warned that people need to do more to help themselves by eating less and exercising more.

We have a rapidly escalating problem with obesity, he said. The situation is getting worse and it is getting worse rapidly. It probably needs Scottish society to decide it is a problem they want to respond to.

Obesity costs the Scottish NHS an estimated £500m a year. By 2010 it is estimated that almost 30% of Scottish adults will be clinically obese.

Meanwhile, parents and doctors are to be issued with charts enabling them to compare the weight and fat levels of children against approved standards. Previous recommendations for a healthy figure have simply set a ratio between height and weight. The new fat charts, backed by the government's Medical Research Council, will tell parents what a healthy child should weigh at any given age, distinguishing between boys and girls.

The measurements in the new charts are based on a two-year study of almost 2,000 children aged between five and 18. They have been compiled using a new technique, bio- impedance analysis which measures the amount of fat, muscle and bone in the body.

The study showed a substantial difference between the amount of fat in a healthy boy and a healthy girl. The researchers found, for example, that at the age of 11 or 12, girls are naturally 60% fatter than boys. Doctors are concerned that teenage girls resort to crash diets in an attempt to shed the extra fat that they need to bear children in future life.

For many years, charts have been available showing healthy childhood height, weight and body mass index (BMI). The BMI, a ratio between height and weight, has been heavily criticised because it does not distinguish between fat, which can lead to health problems, and lean tissue. For example, a muscular athlete with low levels of fat may register as obese under the BMI scale.

Childhood obesity is a very difficult area for doctors and nurses to work in because, for parents, it's very subjective, says Jane DeVille-Almond, an independent nurse consultant who is also a member of the National Obesity Forum.

This, however, will give us a tangible medical guideline to show parents.

Any attempt to combat child obesity can be controversial. Last month government proposals to measure and weigh primary school children annually were attacked by the Royal College of Nursing as an invasion of pupils privacy. It voiced concerns that heavier children might have their self-esteem damaged.

As I'm going in for a Liver biopsy on Friday I suspect this may be the main line of enquiry the Consultant is following. Diagnosis is by a Liver biopsy. My cholestrol is perfect, I'm not diabetic but I am obese, very tired and my liver tests show a high level of enzymes. Looks like a strict diet is on the cards for me.

Tags: Health