National Digestive Diseases Information Clearinghouse
a common, often “silent” liver disease. It results or scans of the liver, this problem resembles alcoholic liver disease, but occurs is called nonalcoholic fatty liver disease in people who drink little or no alcohol.
in this case, it will show that some people Institute of
Diabetes and

liver, along with inflammation and damage.
and Kidney

not aware that they have a liver problem.
Nevertheless, NASH can be severe and NATIONAL

can lead to cirrhosis, in which the liver is OF HEALTH
greater number of Americans with obesity.
In the past 10 years, the rate of obesity hasdoubled in adults and tripled in children.
NASH affects 2 to 5 percent of Americans.
high blood cholesterol, which can further cans have fat in their liver, but no inflam- mation or liver damage, a condition called “fatty liver.” Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage.
U.S. Department
of Health and

Human Services
liver or NAFLD is diagnosed. An impor-tant piece of information learned from the NASH is usually first suspected in a person biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or tests that are included in routine blood test scans can reliably provide this information.
panels, such as alanine aminotransferase(ALT) or aspartate aminotransferase(AST). When further evaluation shows no Symptoms
apparent reason for liver disease (such as NASH is usually a silent disease with few medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging well in the early stages and only begin to studies of the liver show fat, NASH is sus- pected. The only means of proving a diag- simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through worsen, causing scarring or “fibrosis” to damage to liver cells. If there is fat without fibrosis worsens, cirrhosis develops; the A small, slender core of tissue isremoved with a biopsy needle andlooked at under the microscope. liver becomes seriously scarred, hardened, and unable to function normally. Not every once serious scarring or cirrhosis is present, few treatments can halt the progression.
or every patient with diabetes has NASH.
A person with cirrhosis experiences fluid have normal blood cholesterol and lipids.
transplantation is the only treatment for advanced cirrhosis with liver failure, and factor and can even occur in children.
transplantation is increasingly performed one of the major causes of cirrhosis inAmerica, behind hepatitis C and alcoholic While the underlying reason for the liver injury that causes NASH is not known,several factors are possible candidates: • release of toxic inflammatory proteins mon, its underlying cause is still not clear.
• oxidative stress (deterioration of cells) middle-aged and overweight or obese.
Another experimental approach to treatingNASH is the use of newer antidiabetic It is important to stress that there are cur- rently no specific therapies for NASH. The insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glu- cose and fatty acids in the blood than it is for people who do not have NASH. Thenewer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with NASH.
Studies of these medications—includingmetformin, rosiglitazone, and pioglita- zone—are being sponsored by the National they can make a difference. They are also Institutes of Health and should answer the helpful for other conditions, such as heart question of whether these medications are disease, diabetes, and high cholesterol.
A major attempt should be made to lowerbody weight into the healthy range. Weight Hope Through Research
loss can improve liver tests in patients with of NASH is more research to better under- extent. Research at present is focusing on stand the liver injury found in this disease.
When the pathways that lead to the injury are fully known, safe and effective means improvement lasts over a period of time.
can be developed to reverse these pathwaysand help patients with NASH. Recent ical conditions, such as diabetes, high blood steps by which insulin and other hormones conditions should be treated with medica- regulate blood glucose and fat could pro- NASH or elevated liver enzymes should notlead people to avoid treating these other Digestive and Kidney Diseases funds the
NASH Clinical Research Network, which
throughout the United States and a coordi- nating center at Johns Hopkins University.
betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH.
the locations of the clinical centers are For More Information
Points to Remember
American Liver Foundation
1–800–465–4837 or 1–888–443–7222 Phone: 1–800–676–9340 or 212–668–1000 well and may not know that theyhave a liver disease. tion in which the liver is permanentlydamaged and cannot work properly. once the disease is advanced or cir-rhosis is present. tests show high levels of liverenzymes or if scans show fatty liver. small piece of the liver taken througha needle, a procedure called biopsy. reduce their weight, eat a balanceddiet, engage in physical activity,and avoid alcohol and unnecessarymedications. NASH. Experimental therapiesbeing studied include antioxidantsand antidiabetes medications.
National Digestive Diseases
Information Clearinghouse

2 Information WayBethesda, MD 20892–3570Phone: 1–800–891–5389Fax: 703–738–4929Email: nddic@info.niddk.nih.govInternet: The National Digestive Diseases InformationClearinghouse (NDDIC) is a service of theNational Institute of Diabetes and Digestiveand Kidney Diseases (NIDDK). The NIDDKis part of the National Institutes of Healthunder the U.S. Department of Health andHuman Services. Established in 1980, theclearinghouse provides information aboutdigestive diseases to people with digestivedisorders and to their families, health careprofessionals, and the public. NDDIC answersinquiries, develops and distributes publications,and works closely with professional and patientorganizations and Government agencies tocoordinate resources about digestive diseases.
Publications produced by the clearinghouseare carefully reviewed by both NIDDK scien-tists and outside experts. This fact sheet wasreviewed by Anna Mae Diehl, M.D., JohnsHopkins University; and Brent Tetre, M.D.,St. Louis University.
This publication is not copyrighted. Theclearinghouse encourages users of this factsheet to duplicate and distribute as manycopies as desired.
This fact sheet is also available at U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health NIH Publication No. 04–4921January 2004


Americas association for the care of children’s

contents This project manual contains information with regard to your upcoming project. Please take the time to read it thoroughly. It is designed to enhance your experience and better prepare you for your project. The manual contains specific information about travel preparation, health and medical issues, and details about the area to which you will be traveling. If you have any questio

Curiculum vitae

Curiculum Vitae Dept. of Gastroenterology and Hepatology, Room : L-459 Erasmus MC, University Medical Center Rotterdam Summer internship at the Faculty of Mathematics, Uniwersytet Jagielloński, Kraków, Poland Propedeuse (B.Sc.) Medical Biology/Medicine, Utrecht University. 9-certified researcher Experimental Zoology (M.Sc.) Medical Biology/Medicine, Utrecht (cum laude = highest distinct

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