Non-alcoholic fatty hepatosis is the most common liver disease in North America, causing an increase in the prevalence of obesity. However, there are few reliable data on the frequency of NASH in the population, which is due, among other things, to the need for histological confirmation of this diagnosis.

According to the results of the study, in one of the American districts over the past 30 years, the frequency of NASH has tended to increase. According to the results of 555 autopsies performed at the Mayo Clinic, a significant increase in the average body mass index between 1981 and 2010 was recorded, as well as the frequency of obesity in this district. In obese people, the incidence of steatosis increased from 23% in the 1980s to 49% in the 1990s, and then up to 60% today. In addition, in patients of normal body weight, the number of cases of steatosis increased from 12% (80s) to 27% (90s), then to 36% (present).

A similar study of children has shown a tendency to increase the number of NASH over the past 2 decades. The study used data obtained from the National Health and Nutrition Verification Program (NCHP), covering the period from 1988 to 2008. The analysis included more than 10,000 adolescents. The number of obese adolescents increased from 11% to 21% over a 30-year period. The incidence of suspected NASH increased from 4% to 10%. In obese adolescents, the number of patients with elevated levels of aminotransferases increased from 17% to 37%.

The most important aspect is the increase in the number of suspected non-alcoholic liver disease (NBP). This disease is recorded in 10% of adolescents. It should be noted that non-alcoholic liver disease was not found only in overweight adolescents. The prevalence of NBP has increased significantly as obesity, confirming the need for NBP screening in overweight adolescents. The question of the most effective methods of screening and verifying the diagnosis remains debatable. The most important question: are there non-invasive diagnostic methods for NASH?

According to the results of a number of studies, it is possible to assess the condition of the liver using biomarkers of hepatocyte apoptosis and oxidative stress. The circulating markers of liver cell death - fragments of cytokeratin 18 and the soluble Fas protein (Fas ligand) - have been shown to be effective in the diagnosis of NBP and NASH. A prognostic model has also been developed. Further study of these markers has a higher diagnostic value for the detection of NASH compared to the determination of individual markers.

In addition, indicators determined using modern magnetic resonance technologies, such as the measurement of the proton density of lipid fractions, are correlated with the degree of steatosis according to the results of histological examination in adults with from NBP. However, the study showed that the severity of visually assessed steatosis in hepatocytes does not always match the severity of liver disease, so steatosis is not a direct indicator of disease progression. It is necessary to conduct studies evaluating the course of NBP, the relationship between steatosis and liver fibrosis, as well as the possibility of using modern technologies or magnetic resonance methods, such as the determination of the lipid spectrum or modification of fat distribution in dynamics, to assess the stage of the disease.

Overweight and fatty liver patients are at high risk for early morbidity and mortality. The origins of all problems are found in adolescence. The study, the results of which were presented at Digestive Disease Week, assessed the relationship between obesity, fatty liver disease and the risk of developing cardiovascular disease in children. Obesity has been shown to lead to an increased risk of cardiovascular disease compared to patients with familial dyslipidemia. Thus, early diagnosis and timely medical intervention are necessary.

According to another study, moderate obstructive sleep apnea syndrome and hypoxia is characteristic of overweight and NBP patients, confirmed by biopsy. Obstructive sleep apnea syndrome and hypoxia are associated with severe fibrosis in children. The results of the survey of a large multicenter sample of patients showed that NBP is a predisposing factor for the development of hepatocellular carcinoma. It is interesting to note that hepatocellular carcinoma with NBP often develops in patients without cirrhosis. All of the above indicates the need to review existing recommendations for the examination of patients with cirrhosis for the presence of liver cancer.

In conclusion, let us cite the data from one of the studies, in which long-term follow-up of patients with NBP and alcoholic steatohepatitis was carried out with an estimate of the mortality rate associated with hepatic diseases. In patients with NBP and alcoholic steatohepatitis, cirrhosis developed with equal frequency. However, the death rate was higher in patients with NBP than in patients with alcoholic steatohepatitis. These discouraging results underscore the urgent need to increase the volume of ongoing research aimed at reducing the prevalence of obesity and fatty liver disease.