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Nonalcoholic Steatohepatitis (NASH)

What is NASH?

NASH is liver inflammation (hepatitis) and damage caused by a buildup of fat in the liver. Due to the fat buildup, the liver doesn’t work as well, and more severe cases can lead to scarring and cirrhosis. Although most liver disease is caused by heavy drinking, NASH occurs in people who do not abuse alcohol. Risks for developing NASH include obesity, insulin resistance and type 2 diabetes, high cholesterol or triglycerides, and metabolic syndrome. NASH can lead to complications such as cirrhosis, liver failure, and liver cancer.

What are the symptoms of NASH?

Early stages of NASH may be asymptomatic. As NASH progresses and the liver gets further damaged symptoms may include:

  • Fatigue
  • Weight loss for no clear reason
  • General Weakness
  • Ache in the right upper part of the belly

How is NASH Diagnosed?

  • No single test can diagnose NASH. Blood tests, abdominal US, CT, or MRI may be performed to see if fat is building up in the liver. A liver biopsy may also be performed to confirm a diagnosis. 
  • Labs may show increased levels of liver enzymes ALT and AST. 
  • Physical exam may show an enlarged liver, signs of insulin resistance such as darkened skin patches over knuckles, elbows, or knees, and signs of cirrhosis such as jaundice. 

How is NASH treated?

Treatment for NASH includes managing conditions that increase your risk for NASH or make it worse. Currently there are no medications approved to treat NASH. 

  • Reduce total cholesterol levels by limiting saturated fats and starting cholesterol lowering medications. 
  • Reach a healthy weight. Losing only 3-10% of your body weight can make a difference. Weight loss can reduce fat in the liver, inflammation, fibrosis, and scarring. 
  • Control diabetes. Pioglitazone, a medication for type 2 diabetes, improves NASH in people who don’t have diabetes. 
  • Stop or cut back on alcohol consumption
  • Exercise regularly
  • Decrease medication intake specific to medication that can harm your liver
  • Vitamin E and coffee have been shown to reduce inflammation and liver damage.

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