Dr. Umapathy Sundaram has spent decades at the intersection of science and patient care, leading NIH- and VA-funded research aimed at tackling some of the most pressing challenges in gastroenterology. At the forefront of his focus is nonalcoholic fatty liver disease (NAFLD) and its more advanced form, nonalcoholic steatohepatitis (NASH). These conditions, fueled by obesity, diabetes, and modern lifestyles, are among the fastest-growing causes of liver failure worldwide.
As they progress, the risks of cirrhosis, cancer, and early death increase sharply. Around the globe, health systems are struggling to keep pace. The last decade has brought powerful new scientific insights, but Sundaram emphasizes that their true value lies in translation—turning discoveries into better outcomes at the bedside and in patients’ daily lives.
Understanding NAFLD and NASH: From Risk to Diagnosis
NAFLD describes a wide range of liver problems, starting with simple fat buildup (steatosis). Early on, this might not cause harm. Over time, fat can trigger inflammation and injury. When this happens, doctors speak of NASH, a more serious phase that can cause fibrosis (liver scarring) and, if unchecked, cirrhosis or even liver cancer.
Metabolic diseases such as type 2 diabetes, obesity, and insulin resistance significantly increase risk, and these conditions often run together, forming a dangerous cluster. Nearly a third of adults in some countries may have NAFLD without knowing it. Many people feel fine or notice only vague symptoms like tiredness. Since there are few outward signs early on, detection often comes late.
Doctors rely on a mix of tests to pick up these liver changes. Blood work can point to liver stress, such as higher liver enzyme levels, but these changes are not unique to NAFLD or NASH. Imaging tools such as ultrasound, CT, or MRI help spot excess fat, yet they sometimes miss smaller changes. When doctors need to know how much damage has occurred or rule out other causes, a liver biopsy provides clear answers by showing fat, inflammation, and scarring under the microscope.
These steps are not perfect. Blood tests and imaging may miss disease in early phases, and liver biopsies, though accurate, are invasive. This means many people discover their diagnosis only after years of silent liver damage. The search for simple, accurate, and noninvasive tools continues as a top priority in liver medicine. The stakes are especially high in communities where obesity and related conditions fuel rising rates of fatty liver disease.
As highlighted in regional reporting on the growing liver complication of obesity, Non-Alcoholic Steatohepatitis (NASH) is alarmingly common in West Virginia and the Tri-State region. “The most serious form of fatty liver disease, NASH, is now being recognized as one of the fastest-rising threats to liver health,” said Dr. Sundaram.
This trial brought advanced therapies to patients in Appalachia while also generating data critical to understanding how to manage the disease more effectively.
Turning Scientific Advances into Better Patient Outcomes
Over the past decade, steady research has revealed fresh insights into why NAFLD and NASH develop in some people but not others. Genetics play a clear role. Certain inherited changes can make fat build up more quickly or make liver cells prone to injury.
Researchers have also shed light on the gut-liver axis, which describes the complex links among gut bacteria, the immune system, and the liver. This cross-talk shapes how nutrients, toxins, and even signals from our diet reach the liver. For instance, disrupted gut bacteria can send “danger” signals that trigger liver inflammation or change how fat is processed.
Another wave of studies has focused on biomarkers found in blood samples that could predict liver health. Emerging markers track patterns of cell injury, inflammation, or scarring, promising a future where diagnosis becomes as easy as a routine lab draw. Several tests using combinations of these markers now help doctors estimate liver fibrosis risk without a biopsy, though they are still being refined.
“These advances have started to ripple into everyday care,” says Dr. Umapathy Sundaram. “New tools mean earlier detection, which opens the door to earlier, more effective interventions.”
Lifestyle change is key. Modest weight loss can cut liver fat, reduce inflammation, and even reverse fibrosis for some patients. Research shows that losing 7 to 10 percent of body weight can make a real difference. Tighter management of blood sugar and cholesterol, combined with good nutrition, helps too.
Drug development has accelerated, fueled by new study results. Clinical trials now test medications that target different steps in the disease: insulin resistance, fat buildup, inflammation, or fibrosis. While many agents remain under review, recent years have brought the first wave of FDA-approved therapies for NASH in patients with fibrosis.
Coordination speeds up screening, connects patients to new therapies, and improves follow-through. Real-world data from clinics show that patients benefit most when all their conditions, from blood pressure to liver function, are managed together rather than separately.
Emerging Treatments and Patient Experience
Treatment for NAFLD and NASH no longer rests only on diet and exercise, though these remain essential. In the clinic, newer drugs are showing promise. Recent data points to several novel therapies that address liver fat, scarring, or inflammation directly.
One example is obeticholic acid, which has shown benefit in reducing fibrosis in people with NASH. Clinical trials of GLP-1 receptor agonists, already used for diabetes, also point to reduced liver fat and inflammation, owing to their effects on weight loss and metabolism. Ongoing research continues to seek agents that can work even if patients cannot lose weight on their own.
Current options are not magic bullets, and long-term management remains key. Once diagnosed, ongoing monitoring helps track liver function, check for complications, and adjust treatment as needed. Patients are encouraged to attend regular check-ins, incorporate nutrition and physical activity into daily routines, and stick to prescribed medications.
“A true partnership between patients and healthcare teams sets successful cases apart. Patients thrive when they feel empowered by information and supported by a team that responds quickly to new symptoms or setbacks. Education remains central, with ongoing efforts to develop simple materials and coaching that help people stick to new habits,” says Dr. Sundaram.
Translating new scientific knowledge into daily routines has begun to change the story for NAFLD and NASH. Better screening, more accurate diagnosis, and new therapies offer real hope for improved patient outcomes. Widespread change depends on collaboration so that every new discovery finds its way into the clinic.
The future for those affected by NAFLD and NASH looks brighter as more research turns into practical care. In the coming years, more accessible tests, effective medications, and team-based approaches hold the promise to slow, halt, or even reverse the damage. As science continues to unlock answers, the greatest progress will come when every lesson learned reaches patients and brings lasting relief.
