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Final Program


Final Program

322 - Prevalence of NASH in South Asian Populations and Considerations for Rehabilitation with Metabolic Encephalopathy: A Literature Review

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • MB

    Mahita Bandlamudi, MSc

    Medical Student
    A.T. Still University of Osteopathic Medicine in Arizona
    New Hyde Park, New York, United States

    • Co-Author(s)

  • MZ

    Muneeb Zaidi, MD

    Post-Graduate
    Johns Hopkins Bloomberg School of Public Health
    Baltimore, Maryland, United States

  • SA

    Shuchi Amin, MSc

    Medical Student
    Touro College of Osteopathic Medicine
    Floral Park, New York, United States

  • NK

    Nedha Kinnare, B.A.

    Medical Student
    Texas Tech Health Sciences Center
    Lubbock, Texas, United States

  • RZ

    Rahma Zaidi, n/a

    Undergraduate Student
    University of Central Florida
    Orlando, Florida, United States

  • TA

    Thiru M. Annaswamy, MD

    Medical Doctor
    Penn State Health Milton S. Hershey Medical Center
    Hershey, Pennsylvania, United States

Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), previously referred to as Nonalcoholic Steatohepatitis (NASH), has a high prevalence within South Asian (SA) populations. Asian Paradox describes the trend that SA with a lower BMI (23-25 kg/m) are equally prone to developing MASLD when compared to their Western counterparts with a higher BMI threshold ( >30 kg/m). This condition carries significant risks, including progression to cirrhosis and the development of hepatic encephalopathy—a neuropsychiatric complication of liver dysfunction resulting in cognitive impairments and often necessitates admission to inpatient rehabilitation facilities. Within these settings, careful monitoring of electrolytes, bowel movements, and pain management is critical to minimizing complications. It is particularly important to limit the use of opioids in pain management, as they can exacerbate encephalopathy. Additionally, given the increased predisposition of this population to obesity and cardiovascular disease, patient education on lifestyle modifications is essential to mitigate further health risks.

Design:

A search was performed on PubMed using the following keywords: “NASH”, “South Asian”, “Hepatic Encephalopathy”, “MASLD”, and “Physiatry,” which identified a variety of clinical trials and meta-analyses conducted over the past 10 years. Six studies were selected which assessed outcome measures with sufficient power to provide accurate information.

Results: The literature review highlights a high prevalence of MASLD  in SA populations, with rates varying from 5%-30%. Opioids commonly cause constipation, and exacerbate ammonia buildup and worsen encephalopathy. Thus, a proper bowel regimen is heavily recommended in patients with a history of cirrhosis. A common barrier to improving lifestyle modifications is impacting cooking behaviors. Having a specific dietician that specializes in SA cuisine and meals can provide a long lasting lifestyle modification.

Conclusions: A multifaceted approach to managing MASLD and its complications in the SA population is essential. This includes culturally tailored patient education on diet, vigilant inpatient care, opioid-sparing pain management, and optimized bowel regimens.