Nonalcoholic Steatohepatitis (NASH)
What is nonalcoholic steatohepatitis (NASH)?
Nonalcoholic steatohepatitis (NASH) is liver inflammation and damage caused by a buildup of fat in the liver. It is part of a group of conditions called nonalcoholic fatty liver disease. You may be told you have a "fatty liver." Many people have a buildup of fat in the liver, and for most people it causes no symptoms and no problems. But in some people, the fat causes inflammation and damages cells in the liver. Because of the damage, the liver doesn't work as well as it should.
NASH can get worse and cause scarring of the liver, which leads to cirrhosis. But the disease doesn't always get worse.
NASH is similar to the kind of liver disease that is caused by long-term, heavy drinking. But NASH occurs in people who don't abuse alcohol.
What causes NASH?
Experts don't know why some people with a buildup of fat in the liver get NASH and some don't. It could be that something in the environment triggers the inflammation in those people. Or maybe it runs in their families.
Things that put people at risk for NASH and for liver damage include:
- Insulin resistance and type 2 diabetes.
- High cholesterol and high triglycerides.
- Metabolic syndrome.
Most people who have NASH are 40 to 50 years old and have one or more of the problems listed above. But NASH can happen in people who have none of these risk factors.
What are the symptoms?
You may have no symptoms in the early stages of NASH. Most people who have NASH feel fine and don't know that they have it.
As NASH progresses and liver damage gets worse, you may start to have symptoms such as:
- Fatigue (feeling tired all the time).
- Weight loss for no clear reason.
- General weakness.
- An ache in the upper right part of your belly.
It may take many years for NASH to become severe enough to cause symptoms.
How is NASH diagnosed?
No single test can diagnose NASH. Your doctor will ask you about other health problems you've had.
To see if fat is building up in your liver and to rule out other diseases, your doctor may do tests such as:
Your doctor may do a liver biopsy to be sure that you have NASH. In a liver biopsy, your doctor takes a sample of tissue from your liver and checks it for signs of NASH.
How is it treated?
Treatment for NASH includes managing conditions that increase your risk for NASH or make it worse. You can:
- Reduce your total cholesterol level.
- Reach a healthy weight. Losing 3% to 10% of your total body weight can make a difference.footnote 1
- Control diabetes.
- Stop or cut back on drinking alcohol.
- Exercise regularly.
Also, ask your doctor or pharmacist about all the medicines you are taking. Some may harm your liver.
In some cases, your doctor may suggest medicine to control or reverse liver damage caused by NASH.
- Chalasani N, et al. (2012). The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. American Journal of Gastroenterology, 107(6): 811–826.
Other Works Consulted
- Ahmed A, et al. (2006). Alcoholic and nonalcoholic fatty liver disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 547–564. Philadelphia: Saunders.
- American Gastroenterological Association (2002, reapproved 2008). AGA technical review on nonalcoholic fatty liver disease. Gastroenterology, 123(5): 1705–1725.
- Collantes R, et al. (2004). Nonalcoholic fatty liver disease and the epidemic of obesity. Cleveland Clinic Journal of Medicine, 71(8): 657–664.
- National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases (1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available online: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf.
- St. George A, et al. (2009). Independent effects of physical activity in patients with nonalcoholic fatty liver disease. Hepatology, 50(1): 68–76.
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
W. Thomas London, MD - Internal Medicine, Hepatology
Current as ofMarch 28, 2018
Current as of: March 28, 2018