Disease Overview
NASH/Fatty Liver Disease:NASH affects 2 to 5 percent of Americans. An additional 10 to 20 percent of Americans have fat in their liver, but no inflammation 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. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver. Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. Nonalcoholic fatty liver disease (NAFLD) is a major form of chronic liver disease in adults and children. It is one of the consequences of the current obesity epidemic, and can progress to nonalcoholic steatohepatitis (NASH), characterized by steatosis, inflammation, and progressive fibrosis, ultimately leading to cirrhosis and end-stage liver disease. The factors implicated in this progression are poorly understood. NASH is closely associated with obesity and the metabolic syndrome. Recent studies emphasize the role of insulin resistance, oxidative stress, lipid peroxidation, and cytokine release in the development of NASH. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. What is it?Fatty liver is the build-up of excess fat in the liver cells. It is normal for your liver to contain some fat. But if fat accounts for more than 10% of your liver’s weight, then you have fatty liver and you may develop more serious complications. Fatty liver may cause no damage, but sometimes the excess fat leads to inflammation of the liver. This condition, called steatohepatitis, does cause liver damage. Sometimes, inflammation from a fatty liver is linked to alcohol abuse; this is known as alcoholic steatohepatitis. Otherwise the condition is called nonalcoholic steatohepatitis, or NASH. An inflamed liver may become scarred and hardened over time. This condition, called cirrhosis, is serious and often leads to liver failure. NASH is one of the top three leading causes of cirrhosis. Symptoms of Fatty LiverA fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons. NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience fatigue, weight loss, abdominal discomfort, weakness and confusion. Causes of Fatty LiverEating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as obesity, diabetes, or high triglycerides. Alcohol abuse, rapid weight loss and malnutrition may also lead to fatty liver. However, some people develop fatty liver even if they have none of these conditions. Who is at risk for fatty liver?Most (but not all) fatty liver patients are middle-aged and overweight. most commonly linked to fatty liver disease are: What is the best way to prevent fatty liver?The best way to reduce your risk of developing fatty liver is to maintain a healthy weight and normal triglyceride levels. You should also avoid excess alcohol and other substances that could harm your liver.
AgeThe prevalence of metabolic syndrome increases with age, affecting less than 10 percent of people in their 20s and 40 percent of people in their 60s. However, some research shows that about one in eight schoolchildren has three or more components of metabolic syndrome. And, other research has identified an association between childhood metabolic syndrome and adult cardiovascular disease decades later. RaceHispanics and Asians seem to be at greater risk of metabolic syndrome than other races are. ObesityA body mass index (BMI) — a measure of your percentage of body fat based on height and weight — greater than 25 increases your risk of metabolic syndrome. So does abdominal obesity — having an apple shape rather than a pear shape. History of DiabetesYou're more likely to have metabolic syndrome if you have a family history of type 2 diabetes or a history of diabetes during pregnancy (gestational diabetes). Other DiseasesA diagnosis of high blood pressure, cardiovascular disease or polycystic ovary syndrome — a similar type of metabolic problem that affects a woman's hormones and reproductive system — also increases your risk of metabolic syndrome. Metabolic SyndromeMetabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes. Having just one of these conditions — increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels — isn't diagnosed as metabolic syndrome, but it does contribute to the risk of serious disease. If more than one of these conditions occur in combination, the risk is even greater. If you have metabolic syndrome or any of the components of metabolic syndrome, you have the opportunity to make aggressive lifestyle changes. Making these changes can delay or derail the development of serious diseases that may result from metabolic syndrome. SymptomsHaving metabolic syndrome means you have several disorders related to your metabolism at the same time, including: Having one component of metabolic syndrome means you're more likely to have others. And the more components you have, the greater are the risks to your health. Research into the complex underlying process linking the group of conditions involved in metabolic syndrome is ongoing. As the name suggests, metabolic syndrome is tied to your body's metabolism, possibly to a condition called insulin resistance. Insulin is a hormone made by your pancreas that helps control the amount of sugar in your bloodstream. Normally, your digestive system breaks down some of the foods you eat into sugar (glucose). Your blood carries the glucose to your body's tissues, where the cells use it as fuel. Glucose enters your cells with the help of insulin. In people with insulin resistance, cells don't respond normally to insulin, and glucose can't enter the cells as easily. Your body reacts by churning out more and more insulin to help glucose get into your cells. The result is higher than normal levels of both insulin and glucose in your blood. Although perhaps not high enough to qualify as diabetes, an elevated glucose level still interferes with your body processes. Increased insulin raises your triglyceride level and other blood fat levels. It also interferes with how your kidneys work, leading to higher blood pressure. These combined effects of insulin resistance put you at risk of heart disease, stroke, diabetes and other conditions. Combination of FactorsResearchers are still learning what causes insulin resistance. It probably involves a variety of genetic and environmental factors. They think some people are genetically prone to insulin resistance, inheriting the tendency from their parents. But being overweight and inactive are major contributors. Disagreement Among ExpertsNot all experts agree on the definition of metabolic syndrome or whether it even exists as a distinct medical condition. Doctors have talked about this constellation of risk factors for years and have called it many names, including syndrome X and insulin resistance syndrome. Whatever it's called, and however it's precisely defined, this collection of risk factors is apparently becoming more prevalent. Risk factorsThe following factors increase your chances of having metabolic syndrome:
Cardiac Disease:An estimated 80.7 million American adults (1 in 3) have 1 or more types of CVD. Of these, 38 200 000 are estimated to be >60 years of age (extrapolated to 2005 from NCHS NHANES 1999–2004 data). About every 26 seconds, an American will suffer a coronary event, and about every minute someone will die from one. Cardiovascular disease is the leading cause of mortality in the US, accounting for 36.3% of all deaths, or 1 of every 2.8 deaths. CVD total constituted approximately 57% of all estimated deaths in 2007. In every year since 1900, except 1918, CVD accounted for more deaths than any other major cause of death in the United States. Including heart attack and heart failure, approximately 700,000 people die annually from cardiovascular disease. Heart failure accounts for between $21 billion and $40 billion annually, representing approximately 1.5-3% of national health expenditures. The estimated direct and indirect 2008 cost of CHD is $156.4 billion.
Heart Disease:Heart disease is a broad term used to describe a range of diseases that affect your heart, and in some cases, your blood vessels. The various diseases that fall under the umbrella of heart disease include diseases of your blood vessels, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you're born with (congenital heart defects). The term "heart disease" is often used interchangeably with "cardiovascular disease (CVD)", “coronary artery disease (CAD)”, and “coronary heart disease (CHD)”. Coronary artery disease (CAD), also called coronary heart disease, is a condition in which plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. When these blood vessels become hardened or narrowed due to the buildup of plaque it can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as infections and conditions that affect your heart's muscle, valves or beating rhythm also are considered forms of heart disease. CAD is the most common type of heart disease. It's the leading cause of death in the United States for both men and women. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people. Plaque is made up of fat, cholesterol (ko-LES-ter-ol), calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). The left side of this image shows a normal artery with normal blood flow. The progression of disease moves from left to right. The image shows an artery with progressing plaque buildup. Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach your heart muscle. This can cause angina (an-JI-nuh or AN-juh-nuh) or a heart attack. Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is flowing to an area of your heart muscle. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die. Without quick treatment, a heart attack can lead to serious problems and even death. Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias (ah-RITH-me-ahs). Heart failure is a condition in which your heart can't pump enough blood throughout your body. Arrhythmias are problems with the speed or rhythm of your heartbeat.
Type 1Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Type 2Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. With Type 2 diabetes, your body does not make or use insulin well. Symptoms of Type 2 diabetes may include fatigue, thirst, weight loss, blurred vision and frequent urination. Some people have no symptoms. A blood test can show if you have diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your glucose level and take medicine if prescribed. Pre-DiabetesBefore people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. Together with the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association published a Position Statement on The Prevention or Delay of Type 2 Diabetes" to help guide health care professionals in treating their patients with pre-diabetes. There is a lot you can do yourself to know your risks for pre-diabetes and to take action to prevent diabetes if you have, or are at risk for, pre-diabetes. The American Diabetes Association has a wealth of resources for people with diabetes. People with pre- diabetes can expect to benefit from much of the same advice for good nutrition and physical activity. The links on this page are to the information contained on the American Diabetes Association’s website.
Diabetes:There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease. Diabetes is the sixth leading cause of death in the US. By the year 2030, there are projected to be 30.3 million diabetics in the US. When diabetes is not managed properly, serious problems, such as kidney disease, blindness, nerve damage and skin complications can occur. Diabetes also is associated with an increased risk for heart attack, stroke and poor circulation. The Centers for Disease Control and Prevention labels diabetes the “epidemic of our time.” This chronic disease is the leading cause of end stage renal disease, lower extremity amputations, and adult blindness. While the death rates and incidence of most cancers and heart disease have decreased, deaths from diabetes have increased 30% over the past 20 years. Diabetes is most devastating in the Medicare population, where about 19% have the disease. In nursing homes, 18% of the residents are diabetic patients. Type-2 diabetes, the most common form of diabetes, occurs when the body fails to produce sufficient insulin or to properly use the insulin that the pancreas does produce. Type-2 diabetes tends to affect adults and increases with age and obesity. Although there is no cure for diabetes, it can be managed with behavioral and pharmacological interventions. Adequate management of diabetes can prevent severe complications and improve quality of life, in addition to averting the considerable health care costs resulting from uncontrolled diabetes and its associated complications. Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life. Without enough insulin, the glucose stays in your blood. Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves.Diabetes can also cause heart disease, stroke and even the need to remove a limb. There are 4 major types of diabetes; Type 1, Type 2, pre-diabetes and gestational diabetes. There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease. In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform. With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes. There are 4 major types of diabetes:How to Tell if You Have Pre-DiabetesLearn how you may be at risk for pre-diabetes. How to Prevent Pre-DiabetesPre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. Frequently Asked Questions about Pre-DiabetesLearn the answers to these questions and more in this section. Common ConcernsIn this section, learn more about common concerns that people with diabetes face every day. These include what happens when you're sick, and when you travel, should you get a flu/pneumonia shot, and dealing with feelings like anger and depression. |
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