NASH/MASH: A Leading Cause of Liver Related Mortality

Nonalcoholic steatohepatitis (NASH)), also known as metabolic dysfunction associated steatohepatitis, can lead to serious complications.

NASH is a leading cause of liver related mortality and an increasing burden on healthcare systems globally.

NASH is a leading cause of liver related mortality and an increasing burden on healthcare systems globally.1 Additionally, patients with NASH, especially those with more advanced metabolic risk factors (hypertension, concomitant type 2 diabetes), are at increased risk for adverse cardiovascular events and increased morbidity and mortality.2

Once NASH progresses to significant liver fibrosis (consistent with F2/F3) the risk of adverse liver outcomes increases dramatically:

  • The risk of liver related mortality and other liver related events (e.g. transplant) increases meaningfully in patients with increasing degrees of liver fibrosis. Patients with significant liver fibrosis have an approximately 10-17X increased risk of liver-related mortality versus patients without liver fibrosis.3
  • NASH is rapidly becoming the leading cause of liver transplantation in the U.S.4
  • People with NASH have an increased risk of heart attack, stroke and death.2,5

In 2023, global liver disease medical societies and patient groups came together to rename the disease, with the goal of establishing an affirmative, non-stigmatizing name and diagnosis. Nonalcoholic fatty liver disease (NAFLD) was renamed metabolic dysfunction-associated steatotic liver disease (MASLD), NASH was renamed MASH, and an overarching term, steatotic liver disease (SLD), was established to capture multiple types of liver diseases associated with fat buildup in the liver. In addition to liver disease, patients with MASH have at least one related comorbid condition (e.g., obesity, hypertension, dyslipidemia, or type 2 diabetes).

The name change was driven by multinational liver societies, including the American Association for the Study of Liver Diseases, to avoid the use of exclusionary confounder terms and potentially stigmatizing language.6

References

  1. Lazarus JZ, et al. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol. 2022 Jan;19(1):60-78.
  2. Adams LA, et al. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut, 2017; 66(6):1138-1153.
  3. Dulai PS, et al. Increased risk of mortality by fibrosis stage in non-alcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology. 2017 May; 65(5): 1557–1565.
  4. Younossi ZM, et al. Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2021;19(3):580-589.
  5. Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment. Diabetes Metab. 2021 Mar;47(2):1012154.
  6. Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023 Dec 1;78(6):1966-1986.

NASH is the leading cause of liver transplant among women in the U.S.