According to the Digestive Diseases Research Institute of Tehran University of Medical Sciences, the increasing concerns about the ascending prevalence of fatty liver disease and chronic hepatitis due to it (NAFLD and NASH) as a potentially dangerous but completely preventable disease, have led the world to name the June 12 as the "International Day of NASH".
The purpose of naming the "International Day of NASH", which experienced the first year of implementation in 2018, was to attract the global attention of the general populations, at-risk patients, the medical community, planners, public health providers and the media to this disease's silent epidemic, raise the society's awareness of its symptoms and causes, and find better ways for its faster diagnosis and more effective treatment options.
According to the Global Liver Institute, based in Washington DC, US, which is the host of the "International Day of NASH", and coordinates dozens of centers for liver related illnesses around the world to educate and support patients at-risk of this disease, there is an urgent need to increase awareness and also educate the society about non-alcoholic fatty liver disease.
One hundred and fifteen million adults afflicted with fatty liver disease in the world
Currently, 115 million adults (12% of the adults population) are affected by fatty liver disease worldwide. In the United States, approximately 30 million people are afflicted with this disease, and it is expected that by 2030, its prevalence will increase by 63%.
Global efforts to provide new technologies for the early diagnosis of fatty liver disease
Global efforts are seeking to stop and even reverse the rapidly rising epidemic of fatty liver disease (NAFLD and NASH). The main focus of the programs is to promote early intervention; hence, in addition to preventive interventions, large companies are now leading the global efforts for non-invasive laboratory tests for early diagnosis of non-alcoholic liver disease, to prevent the spread of this disease worldwide. An organized campaign called "Beyond Biopsy" is another example of these efforts to present non-invasive technologies as alternatives to biopsy.
Six million people in the world, with advanced NASH
According to Dr. Younesi, a prominent researcher in the field of fatty liver disease at the NASH International Day Congress, more than 6 million adults in the world are afflicted with advanced NASH, while the cost of the treatment of these patients has imposed a financial burden of more than $ 200 billion directly and $ 95.4 billion indirectly.
According to him, although NASH was detected and discovered almost 40 years ago, its prevalence has doubled in the past 15 years, and challenges remain to optimize disease diagnosis and control.
Dr. Younesi noted that between 2015 and 2030, non-alcoholic fatty liver disease (NAFLD), which is associated with NASH, rises from 20% to 27%.
Why the non-alcoholic fatty liver disease prevalence risk should be taken very seriously?
The contribution of fatty liver disease to myocardial infarctions, brain strokes and early deaths
Dr Malekzadeh, the head of the Iranian association of gastroenterologists and hepatologists said: "An important point about fatty liver disease and chronic hepatitis due to it (NAFLD and NASH) is that the serious complications of this disease are not just involving the liver; most people afflicted with this disease may even don't face any serious liver problem until the end of their lives, but they could be prone to high blood pressure, high blood glucose, myocardial infarctions and strokes, and kidney failure, as the most important cause of death in fatty liver disease patients is myocardial infarctions and strokes, and fatty liver disease is a major contributor to myocardial infarctions and strokes, and consequently early deaths. According to statistics, 64% of people who die from these diseases in the country are under 70 years old, and 22% of them are under 50 years old who die very early!"
Every year, 10,000 Iranians develop cirrhosis
The head of the Iranian association of gastroenterologists and hepatologists said: "Available studies from liver biopsy specimens show that liver failure (cirrhosis) occurs in about 25% of patients with NASH."
According to him, 10,000 people in Iran develop liver failure (cirrhosis) every year, including 5,000 deaths.
The head of the Digestive Diseases Research Institute of Tehran University of Medical Sciences emphasized that currently NASH is the most common cause of liver disease in Iran, and its prevalence is projected to increase in the future.
Dr Malekzadeh said that unfortunately the contribution of liver cirrhosis due to non-alcoholic fatty liver, which occurs mainly because of overeating, inactivity and obesity, is increasing in association with chronic liver failure; and cirrhosis due to non-alcoholic fatty liver disease, is far more prevalent than cirrhosis due to chronic hepatitis C or B in Iran. Also he added that it could result in an increase in the number of people requiring liver transplantation or deaths due to this disease in the future.
The annual death of more than 5,000 Iranians due to chronic liver diseases
To give an example, he pointed to the statistics of deaths due to liver failure in both sexes in Iran in 1396, and said: "In 1396, 5400 people in the country died due to chronic liver diseases. Out of this total, 4000 people, including 3000 (56%) were under the age of 70, and 1000 (19%) were under the age of 50, who suffered from early and very early deaths."
The annual early death of 32,000 Iranians due to gastrointestinal and liver diseases
The head of the Iranian association of gastroenterologists and hepatologists also mentioned the 32,000 annual early deaths due to gastrointestinal and liver diseases in Iran (59% under the age of 70 and 17% under the age of 50), and said that among these deaths, hepatic cirrhosis can cause more than 5,000 deaths per year. He added that: "Unfortunately, 64% of deaths due to hepatic cirrhosis occur under the age of 70 and 22% occur under the age of 50."
Obesity as the most important risk factor for non-alcoholic fatty liver
According to Dr.Malekzadeh, what is significantly evident in the results of all studies related to controllable non-alcoholic fatty liver disease is a strong association of obesity, especially abdominal obesity, with this disease. So that 70% of patients with non-alcoholic fatty liver disease are obese people, of course diabetes and hyper cholesterolemia are also among the underlying causes of the disease.
The Deputy Minister of Health Research said that the risk of developing non-alcoholic fatty liver becomes more serious with increasing obesity, and unfortunately, obesity in Iran has increased rapidly over the past 20 years. Currently, 29 million Iranians are obese and overweight, and 85% of Iranians do not have enough mobility.
The villagers surpassed urban populations in obesity
The gastroenterology privileged professor of Tehran University of Medical Sciences referred to the latest global article published in Nature on the trend of increasing body mass index in 200 countries, and described the prevalence of obesity in Iran, especially in villages and mostly among rural women, very worrying.