While the Ministry of Health has promised a new plan to fight obesity for 2023, the day of Thursday, June 8, dedicated to the fight against “fatty liver disease” or “Nash” (for non-alcoholic steatohepatitis ), shines the spotlight on a harmful and often overlooked consequence of being overweight on health: the accumulation of fat in the liver.
“The term Nash is often misused,” immediately emphasizes Professor Laurent Castera, hepatologist at Beaujon Hospital and author of How to Save Your Liver (Ed. Dunod). “In France, it is estimated that 10 million French people have fatty liver, that is to say that they present on ultrasound with steatosis (an accumulation of fat in the liver, editor’s note). Nash is the advanced form of foie gras and affects roughly one million people. It is defined by inflammation and the risk of developing fibrosis, or even cirrhosis,” says the specialist.
General practitioners on the front line
Long associated with excessive alcohol consumption, cirrhosis can also be the consequence of a diet that is too rich. “In the United States, junk food is becoming the number one cause of cirrhosis,” says Professor Castera. A reality still unknown to health professionals themselves. “Doctors are aware of the risk of diabetes or cardiovascular disease in obese people, but they are more rarely concerned about their liver,” says Dr. Pascal Mélin, president of the SOS Hepatitis and Liver Diseases Federation.
Five main factors expose you to the accumulation of fat in this organ: age (the frequency increases from the age of 40), type 2 diabetes, overweight or obesity, arterial hypertension or a rate of high cholesterol. “If you combine all these risks, the frequency of the disease rises to 90%, if you have none, we drop to 5%”, summarizes Professor Laurent Castera, who insists on the importance of screening. “As in all chronic liver diseases, the risk is to develop cirrhosis without realizing it, because it does not cause symptoms. A free score, the FIB-4, based on a simple blood test, allows your doctor to suspect it; it is then necessary to see a specialist to carry out a Fibroscan, a non-invasive, quick and painless examination which makes it possible to measure the hardness of the liver. »
For Laurent Castera, the arrival of treatments could mark a turning point in the detection of the pathology – currently, no drug can treat fatty liver disease. “For the moment, the treatment consists of implementing lifestyle and dietary rules and doing physical exercise in order to achieve weight reduction. But many molecules are being evaluated, in particular in phase 3 therapeutic trials, which should lead to the approval of a drug by the FDA in the United States by next year, “he rejoices. .
At the risk of prevention being neglected? This is what Doctor Mélin fears. “We risk falling into the same pitfall as for cholesterol. Patients who have too much are given treatments that allow them to continue eating what they want rather than losing weight or being active. Not to mention the lobbying of laboratories which will have no interest in prevention progressing, ”he anticipates.
“A huge amount of awareness-raising work remains to be done on eating habits and physical activity”, abounds Laurent Castera, who repeats it: “In fatty liver disease, the number one enemy is not fat as we might think so, but sugar, the excess of which in the blood is stored as fat in the liver. Hence the importance of learning to detect it in food, as the Federation SOS Hepatitis and Liver Diseases invites with the challenge “June without added sugars”. “The idea is to look more at the labels to realize how much sugars are everywhere,” explains Pascal Mélin. Including where you don’t expect them, like in mayonnaise or ham…