Obese people
Obesity is a contributor to fatty liver disease. Photo via Pixabay

By Rohit Loomba

As you read this, a new kind of disease is quietly impacting San Diegans, though most don’t realize they’re targets.

It’s a potential killer called nonalcoholic steatohepatitis or NASH, a fatty liver disease that is emerging as one of California’s and the nation’s largest public health problems.

Our livers are incredibly vital, responsible for more than 150 bodily functions, such as controlling blood sugar levels and producing proteins important for blood clotting.

The liver also filters blood, breaks down the medicines we take and while it produces, transforms and transports fat, it’s not designed to store it.

And therein lies the problem and threat to our health.

With NASH, in susceptible individuals, the liver becomes overwhelmed by things like excessive sugar intake. It compensates by storing the excess as fat.

If nothing changes, like diet or exercise, the fatty liver becomes inflamed and the condition can progress to nonalcoholic cirrhosis, liver failure, liver cancer, the need for a liver transplant and even death, usually from cardiovascular disease.

Rohit Loomba

By 2020, NASH may become the leading cause of liver transplantation in the United States.

NASH’s most troubling characteristic is its silence. It doesn’t present symptoms until well advanced when the damage may be irreparable. Many patients with NASH don’t know they have the condition until the consequences are dire.

And since many patients show no symptoms, many physicians and clinicians do not screen for NASH.

Overall, an estimated 30 million American adults, including an unknown number of San Diegans, have NASH. The disease can also affect young children and adolescents.

There is no current treatment for NASH, but its harmful effects can be moderated with strict and sustained lifestyle changes, such as diet and exercise.

Happily, there is progress toward effective treatment and perhaps someday a cure.

The NAFLD Research Center in the Altman Clinical and Translational Research Institute (ACTRI) at UC San Diego Health is a major hub of innovation and practice-changing science in the diagnosis and treatment of NASH and related conditions.

Over the last decade, my colleagues and I have developed advanced magnetic resonance imaging assessments for liver fat measurements and led a series of major clinical investigations. Several seminal studies are now under way at the center which may dramatically impact future clinical practice.

And on June 12, leading San Diego physicians, hepatologists, potential patients and their families, San Diego healthcare businesses and other interested stakeholders will join me at ACTRI for the world’s first International NASH Day — a day of workshops to educate and activate about the disease, potential medicines and preventative measures San Diegans and others can take to live longer, healthier lives.

Similar education and engagement sessions will take place in San Antonio, New York City, Washington, D.C., and in world capitals like Paris, Mexico City, Madrid and others.

We invite all readers to speak with their primary care providers, internists, family practitioners and diabetologists about NASH and the risks of fatty liver disease. Silence is not a virtue; a conversation cannot happen too early.


Dr. Rohit Loomba is director of the NAFLD Research Center and professor of medicine, director of hepatology at UC San Diego School of Medicine and UC San Diego Health.

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