{"id":4782,"date":"2024-08-14T08:01:00","date_gmt":"2024-08-13T22:31:00","guid":{"rendered":"https:\/\/hepatitissa.asn.au\/communitynews\/?p=4782"},"modified":"2024-08-22T17:05:46","modified_gmt":"2024-08-22T07:35:46","slug":"the-hepatic-threat-overtaking-hep-b-and-hep-c-in-the-us","status":"publish","type":"post","link":"https:\/\/hepatitissa.asn.au\/communitynews\/2024\/08\/the-hepatic-threat-overtaking-hep-b-and-hep-c-in-the-us\/","title":{"rendered":"The Hepatic Threat Overtaking Hep B and Hep C in the US"},"content":{"rendered":"\n

by Madona Azar<\/a>, UMass Chan Medical School<\/a><\/em><\/p>\n\n\n\n

Liver disease is frighteningly common worldwide. <\/p>\n\n\n\n

Metabolic dysfunction-associated steatotic liver disease, or MASLD<\/a>, is an umbrella term describing conditions related to a buildup of fat in the liver. Formerly known as nonalcoholic fatty liver disease, this condition affects one in four people worldwide<\/a>. Among those with type 2 diabetes<\/a>, insulin resistance, obesity or all three, the prevalence of MASLD increases to three in four people<\/a>.<\/p>\n\n\n\n

As a diabetologist<\/a>, the possibility of liver disease is on my mind every time I see a patient. Understanding your risk of developing this common yet under-recognised condition is essential to treating it.<\/p>\n\n\n\n

What is MASLD?<\/h2>\n\n\n\n

MASLD is a complex disorder with both environmental and genetic contributions. In its early stages, liver cells accumulate fat in a process called steatosis. Major sources of this fat<\/a> include adipose tissue as well as fatty acids the liver makes in response to insulin resistance and excess caloric intake. This fat accumulation can enlarge the liver and interfere with its normal functioning.<\/p>\n\n\n\n

Over time, fatty acids activate enzymes, which can produce toxic byproducts capable of causing liver cell injury, inflammation and scarring. This condition is better known as MASH, or metabolic dysfunction-associated steatohepatitis<\/a>. Progression to MASH is more common in the presence of other risk factors such as type 2 diabetes, insulin resistance and metabolic syndrome.<\/p>\n\n\n\n

Left unaddressed, MASLD and MASH can progress to liver scarring, failure and, in some cases, cancer<\/a>. They also increase risk of death from cardiovascular disease<\/a> and liver-related complications.<\/p>\n\n\n\n

In the U.S., MASH is the leading cause of liver transplants due to hepatic cancer<\/a> among women and in those 65 and older. It is also on track to overtake hepatitis B and C as the main reason people develop liver cancer<\/a> and thus need a liver transplant.<\/p>\n\n\n\n

Liver disease and type 2 diabetes<\/h2>\n\n\n\n

Three out of four people<\/a> with type 2 diabetes have MASLD. Linking liver disease, type 2 diabetes and obesity is the key role insulin resistance<\/a> plays in their genesis.<\/p>\n\n\n\n

Obesity is associated with increased fat deposits around the internal organs and higher levels of fatty acids delivered to the liver. Accumulation of fat in the liver increases its resistance to insulin<\/a>.<\/p>\n\n\n\n

Normally, insulin suppresses glucose production in the liver when blood sugar is high. When the liver becomes resistant to insulin, it produces more glucose<\/a> despite elevated blood sugar levels, which in turn contributes to the development of type 2 diabetes.<\/p>\n\n\n\n

A 2015 meta-analysis found that people with MASLD have a nearly twofold greater risk<\/a> of developing type 2 diabetes than those without the disease. MASLD is also more likely to progress to MASH<\/a> in the presence of type 2 diabetes.<\/p>\n\n\n\n

MASLD disproportionately affects certain ethnic groups. For instance, one in five people of Hispanic descent in the U.S.<\/a> have MASLD, with or without diabetes. This is thought to be related to genetic mutations that affect how the liver cells process fat. One particular mutation<\/a> more common in Hispanic people promotes steatosis by interfering with the cells\u2019 ability to clear fat deposits.<\/p>\n\n\n\n

Treating MASLD and MASH<\/h2>\n\n\n\n

The silver lining is that management of obesity and type 2 diabetes \u2013 such as through lifestyle changes<\/a> \u2013 is very similar to management of MASLD. The most critical early interventions for type 2 diabetes can also help with MASLD, and this is not surprising given how closely interrelated these two conditions are.<\/p>\n\n\n\n

The best way to reverse the early stages of MASLD is with weight loss through healthy eating habits and regular exercise<\/a>. The aim is to shed at least five to ten per cent of initial body weight, maintain that weight loss through sustainable and realistic lifestyle choices, and avoid excess alcohol intake to limit additional liver injury.<\/p>\n\n\n\n

Treatments and lifestyle changes need to be deployed as early as possible, before inflammation and scarring have firmly set in.<\/p><\/blockquote><\/figure>\n\n\n\n

New medications to treat diabetes<\/a>, such as GLP-1 receptor agonists like Ozempic and Mounjaro<\/a>, as well as SGLT2 inhibitors like Jardiance or Invokana, have also shown benefit in early stages of MASLD. These drugs promote weight loss, which in turn improves MASLD. In addition, studies have shown that Ozempic<\/a> and Mounjaro<\/a> could reverse MASH, even with inflammation and fibrosis.<\/p>\n\n\n\n

Older medications used for diabetes, such as pioglitazone<\/a>, typically can also help reduce the progression of MASH by reducing insulin resistance. Liver disease progresses in stages of increasing damage.<\/p>\n\n\n\n

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