A Steep Price to Pay for Untreated NASH

A new study in the January issue of Diabetes Care makes one thing very clear. We pay a steep price for untreated NASH – nonalcoholic steatohepatitis. This is a disease that starts with fat tissue building up in the liver. Then inflammation develops. After that, it can progress to liver damage and failure, ultimately requiring a transplant.

Zobair Younossi and colleagues write that more than 18 million people are living with NASH and type 2 diabetes in the U.S. Over the next 20 years, they estimate that the medical costs for those patients will add up sharply – to $56 billion. That’s because they’ll need 65,000 liver transplants. They will suffer high rates of heart disease and liver cancer. The price for treating those complications is high and the loss of life and health is siginificant.

Often Treated After Complications Mount

Because it’s not easy to monitor, NASH often progresses unnoticed until it’s at an advanced stage. And even when physicians note that something is going on, the medical advice is often casual and ineffective. Tony Villiotti, President of NASH kNOWledge, described his experience for us recently in a guest post:

In 2005, about 15 years after my diabetes diagnosis, the same doctor told me that my liver enzymes were high and that I had a fatty liver. Lose some weight he said, but didn’t make a big deal of it.

Sadly, Villiotti’s experience is not uncommon. Casual advice to lose weight is utterly ineffective for obesity and thus it does nothing to slow the progression of fatty liver disease. But it’s pretty typical in primary care where many providers have too little training and awareness of evidence-based obesity care.

Treatment Options

Nonetheless, patients and providers have options. With a diagnosis of type 2 diabetes, obesity, and early stages of liver disease, referral to an obesity care provider is an important step. These are patients for whom the full range of treatment options deserve careful consideration. Shared decision making requires a shared appraisal of risks. In Villiotti’s case, the risks of NASH were left out of discussions with his provider until the disease had progressed to an advanced stage.

But beyond sound obesity care, new treatments for NASH itself are coming. Intercept has a promising drug that will be in front of an FDA panel in April. We will learn more about its benefits and risks in the days leading up to this public hearing.

Patients at risk for NASH deserve better care. In the end, we all pay a high price for untreated NASH. It’s both a medical and an economic burden.

Click here for the paper in Diabetes Care and here for more on monitoring NAFLD and NASH .

Periportal Steatohepatitis, photograph © Nephron / Wikimedia Commons

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January 11, 2020