Patient Information about Non-Alcoholic Steatohepatitis (NASH)

What is NASH? NASH is a form of fatty liver disease. According to researchers, one in four people is affected by fatty liver disease, which can develop for a number of reasons. There is good news, though. The effects of NASH can be reversible, mainly through lifestyle modifications. Changes such as eating healthier, increasing activity, and losing weight can improve or even reverse the effects of NASH. Knowing your risk is the first step to taking control of the disease.

How does NASH develop?

One of the primary functions of the liver is to process fat; whether breaking down carbohydrates and proteins for use by the body, or synthesizing other fats, like cholesterol, either for use in the body or removal (think: bathroom).

But the liver isn’t meant to store fat. When there is too much buildup of fat in the liver (more than 5%), this is called steatosis. As a means to protect the liver, inflammation and scarring (or fibrosis) starts to occur, and can negatively impact the liver’s primary jobs if it continues to progress without intervention, mainly through lifestyle changes.

When this happens in someone who is not a heavy drinker, it is referred to as Non-Alcoholic Steatohepatitis, or NASH.

 

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What are the stages of NASH, and how serious are the risks?

If left unchecked, NASH can be deadly. In essence, there are three main stages of NASH:

  • Mild (Stage 1) – Fat in the liver exceeds 5% (steatosis), inflammation occurs, and the liver is bigger than normal. Typically in stage 1, the liver will continue to function as it normally would, but may be compromised. This is also referred to as Compensated Cirrhosis, or NASH without Fibrosis.
  • Moderate (Stage 2) – In addition to stage 1 characteristics, scarring (fibrosis) begins to appear. Fibrosis can be classified as F1 through F4; Stage 2 of NASH involves fibrosis from F1 to F3. When a patient reaches this stage, the liver begins to deteriorate into liver failure. This is also referred to as NASH with Fibrosis.
  • Severe (Stage 3) – The most severe stage of NASH, the disease deteriorates into full-on cirrhosis or liver cancer. When this happens, the only option left is a liver transplant.

There are additional risks involved with a NASH diagnosis. The liver is at the center of the body’s metabolic processes, balancing out the body’s good and bad cholesterol – HDL and LDL, respectively. Damage to the liver as a result of NASH can release molecules into the bloodstream that can be harmful for the cardiovascular system.

Symptoms and Warning Signs: What to Look for with NASH

NASH symptoms might not be immediately visible to people in the early stages of the disease. Most people who have NASH feel fine and probably don’t know they have it. As the disease progresses, however, and liver damage gets worse, they may start to see a worsening of symptoms, including:

  • Extreme tiredness.
  • Unexplained weight loss.
  • General weakness.
  • Aching in the upper right part of the abdomen.

It may take many years for NASH to become severe enough to cause symptoms.

Diagnosing NASH

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:

  • Biopsy
  • Blood tests
  • An abdominal ultrasound
  • A CT scan
  • An MRI scan

In some instances, a physician might request a liver biopsy to help diagnose NASH.

How lifestyle plays a role in NASH

Typically, most people who develop NASH are between 40 and 50 years old, and have one or more health concerns. On the other hand, it is possible for individuals with none of these risk factors to develop NASH.

There is no consensus as to why some patients develop NASH and others do not. While environmental factors and family genetic history are potential causes that could trigger the disease, there are still a lot of unknowns.

What science does agree on are the factors that can put people at risk for NASH and liver damage:

The best course of action is managing the conditions that can increase an individual’s risk for NASH, or exacerbate the disease. This includes:

  • Reducing total cholesterol levels.
  • Maintaining a healthy weight. Some research has suggested that reducing as little as 3-10% of your total body weight can make a difference.
  • Control diabetes.
  • Stop or cut back on drinking alcohol.
  • Exercise regularly.

Type 2 Diabetes and NASH

Type 2 diabetes influences the relationship between NAFLD/NASH and cardiovascular disease. According to research, NAFLD was found in 50% of patients with type 2 diabetes who had an otherwise healthy liver. In addition, NAFLD/NASH-related cardiovascular issues are nearly twice as likely in individuals with type 2 diabetes.

NAFLD/NASH and type 2 diabetes share many of the same risk factors: inactivity, obesity, genetics and environmental factors all add to the occurrence of these diseases. In addition, people with type 2 diabetes are at greater risk of advanced fibrosis, which is a major indicator of NASH.

While serious, the good news is that the same measures to help prevent and treat type 2 diabetes – eating healthier, exercise, weight management – can improve NAFLD and NASH prognosis.

NASH definitions to know

  • Biopsy: a procedure where a sample of tissue is taken from the body to perform further diagnostic testing. In the case of NASH, that tissue is taken from a patient’s liver.
  • Cirrhosis: Also known as liver cirrhosis or hepatic cirrhosis, cirrhosis is a condition where the liver does not function properly due to long-term damage, typically characterized by the replacement of normal liver tissue by scar tissue.
  • Fatty liver disease: Fatty liver disease is a condition where excess fat builds up in the liver. Often there are no or few symptoms. There are two types of fatty liver disease: non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD). NAFLD is made up of simple fatty liver and non-alcoholic steatohepatitis (NASH). The primary risks for fatty liver disease include alcohol, type 2 diabetes, and obesity.
  • Fibrosis: Also known as fibrotic scarring, fibrosis is a thickening of connective tissue in the body. It can occur as the result of normal healing, or due to excess tissue deposits. In the case of NAFLD and NASH, fibrosis is the result of the latter, also known as scarring.
  • Liver: The liver is an organ located at the upper right area of your abdomen. While it performs hundreds of functions in the body, its main jobs are: controlling blood sugar levels; filtering all materials (including foods, medicines, and alcohol) in the body; and processing fat.
  • NAFLD: Non-alcoholic fatty liver disease, or NAFLD, is a collective term used to describe a group of conditions where there is an abnormal accumulation of fat in the liver in those who drink little to no alcohol.
  • NASH: NASH stands for Non-Alcoholic Steatohepatitis. It is a liver disease from the family of NAFLD (non-alcoholic fatty liver disease).
  • Steatohepatitis: A type of fatty liver disease characterized by inflammation of the liver with coexisting fat accumulation in liver. This can occur due to prolonged alcohol intake, or other causes – in which case the disease is classified as ASH.
  • Steatosis: Also called fatty change, steatosis is abnormal retention of fat within a cell or organ. Steatosis most often affects the liver, where the condition is commonly referred to as fatty liver disease.