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Non-Alcoholic Steatohepatitis (NASH): What Is It and Am I at Risk?

It is widely known that alcohol use can cause liver damage, but other risk factors make it possible to develop liver disease even if you drink little to no alcohol. Non-alcoholic steatohepatitis (NASH) is a condition that falls under the umbrella of non-alcoholic fatty liver diseases (NAFLD), which are caused by fat buildup in the liver. This can lead to inflammation and scarring. A NASH diagnosis means the liver has accumulated enough fat to have chronic inflammation and cell death.

About 12 percent of the population in the United States is affected by NASH, but given the difficulty of diagnosis, that number is likely higher. Researchers estimate that NASH will become the leading cause of liver transplants in the U.S. between 2020 and 2025.

A Silent Condition

The tricky thing about NASH is that people who have it typically have few or no symptoms, which often results in a late diagnosis when the liver is already seriously damaged.

As NASH progresses, you may experience:

  • Unexplained weight loss
  • Fatigue
  • Weakness
  • Aching in the upper right abdomen

Warning signs that indicate more advanced stages of the disease include:

  • Jaundice
  • Abdominal swelling or distention
  • Confusion
  • Bleeding from the gastrointestinal tract

It can take years for NASH to get severe enough to cause symptoms. NASH is heavily impacted by your lifestyle choices, so understanding the risk factors can greatly reduce your chances of developing this disease.

Evaluating Your Risk Factors

Not everyone who has NAFLD develops NASH, and researchers are still trying to figure out why that is. But several factors contribute to build-up of fat in the liver, including:

  • Obesity
  • A sedentary lifestyle
  • Insulin resistance and Type 2 diabetes
  • High cholesterol
  • High triglycerides
  • Metabolic syndrome
  • Hypertension

NASH is also associated with other medical conditions such as hypothyroidism, obstructive sleep apnea, and polycystic ovary syndrome.

If you have any of these risk factors, controlling them can help reduce your risk for developing NASH. Healthy lifestyle changes are essential.

“Maintaining a healthy body weight and getting regular physical activity are the most effective ways to prevent NASH,” says Rebecca G. Kim, MD, assistant professor of medicine in the Division of Gastroenterology, Hepatology, and Nutrition at University of Utah Health. “For people who have risk factors, taking medications to help control blood pressure, improve cholesterol levels, and decrease their glucose or sugar levels will help lower their risk for NASH.”

Diagnosis Difficulties

No single test can diagnose NASH. If you have any of the above risk factors accompanied by symptoms, your doctor will determine if there is fat build-up on the liver, which can be done by performing:

  • Blood tests
  • MRI scan
  • CT scan
  • Ultrasound
  • Elastography, a special ultrasound that checks the liver for fibrosis

If anything suspicious comes back in these tests, your doctor will need to perform a liver biopsy to confirm NASH. This is an invasive procedure where a needle is inserted through the skin and into the liver to collect a sample. While a liver biopsy is the current gold standard for diagnosing NASH, there are some risks associated with the procedure, such as pain, bleeding, and infection.

Kim says there is currently a lot of research looking into finding non-invasive and affordable ways to diagnose and monitor NASH so patients can start managing their condition sooner.

Living with NASH

If you receive a NASH diagnosis, your quality of life will be based on your current level of liver damage.

Low to Moderate Levels of Damage

If your liver has minimal or moderate scarring, NASH does not affect your quality of life or life expectancy. Controlling your risk factors and losing weight can help improve or reverse your scarring.

Severe Levels of Damage

If you develop advanced scarring, known as cirrhosis, it can have an impact on your quality of life. If NASH cirrhosis is diagnosed early, the life expectancy is about 10 to 15 years. However, if you develop complications such as swelling or fluid in the abdomen, confusion, or bleeding from the gastrointestinal tract, life expectancy decreases dramatically to three to five years without a liver transplant.

Regardless of how advanced your liver scarring is, everyone diagnosed with NASH should avoid alcohol.

“Even though alcohol is not what led to liver disease, research has shown that alcohol, even small to moderate amounts, will add to the liver damage caused by NASH,” Kim says.

If you’ve recently been diagnosed with NASH or have any of the known risk factors, talk to your doctor about the lifestyle changes you can incorporate into your daily life to keep your liver healthy.