High-dose Niacin is a promising treatment for Non-Alcoholic Fatty Liver Disease

For 25-30% of patients, NAFLD progresses from steatosis (the buildup of fat in the liver) to non-alcoholic steatohepatitis (often called NASH), and is characterised by inflammation of the liver. For about a fifth of these patients, this disease can further progress to fibrosis (scarring of the liver) and cirrhosis (the scarred liver cannot function correctly), manifesting clinically in stomach haemorrhage, liver failure, liver cancer and, ultimately, death. Indeed, NAFLD is estimated in a few years to become the leading cause of liver transplantation. Disease progression is slow; it can take decades for cirrhosis to develop from steatosis. Since the early disease stages (steatosis and steatohepatitis) are asymptomatic, the patient is unaware of this ‘ticking time bomb’ health risk. This ignorance is unfortunately shared with healthcare professionals who underdiagnose and hence underestimate the prevalence of this disease.