Nonalcoholic steatohepatitis (NASH) is the most common liver disease in America. It is caused by a buildup of fat in the liver. Over time, the accumulation of fat in the liver can progress to inflammation and later scarring of the liver. In advanced cases, NASH can lead to life-threatening conditions like cirrhosis, liver failure and liver cancer.
Causes Of NASH
Liver disease that is not related to alcohol is most commonly seen in people who are overweight. Obesity, high cholesterol, diabetes and other metabolic conditions are strongly linked to NASH.
Patients with polycystic ovary syndrome (PCOS) also face a higher risk for NASH. This is due to the elevated levels of androgens (male hormones), insulin resistance and obesity often associated with PCOS. Sleep apnea and hypothyroidism (an underactive thyroid) are other conditions that increase the risk for liver disease. Psoriasis and Psoriatic arthritis are also linked to NASH.
In addition to obesity, lifestyle factors such as a poor diet and being sedentary contributes to the development of NASH.
NASH Symptoms
It is uncommon for symptoms to develop in the early stages of NASH. Most patients won’t experience symptoms until the disease progresses further. When they do occur, symptoms include fatigue and pain or discomfort in the upper-right abdomen. If the damage progresses, patients may experience jaundice (yellowing of the skin and eyes), itchy skin, and swelling in the abdomen and/or legs.
Diagnosis And Treatment
If initial blood tests reveal elevated liver enzymes, further diagnostic steps are indicated. These include imaging tests like an ultrasound or a liver fibroscan. Generally, it is not necessary to perform a liver biopsy, but this is performed in cases with conflicting data.
Treatment for NASH primarily focuses on lifestyle modifications and managing co-existing conditions. Weight loss, a healthy diet and regular exercise are crucial for improving liver health and even reversing the damaging effects of NASH. It is also extremely important to avoid any further stress on the liver. Patients are strongly advised to abstain from alcohol. For individuals with underlying conditions like diabetes or high blood pressure, proper treatment and management of these conditions are equally vital to prevent further liver complications.
The best and most studied diet is the Mediterranean diet. In general, if weight loss is desired, the focus needs to be on reducing carbohydrates in the diet.
NASH is a serious liver disease that can lead to significant liver damage, poor quality of life and even death. While leading a liver-healthy lifestyle can help prevent nonalcoholic liver disease, it is crucial to consult your doctor if you are at high risk or if you develop symptoms.
The Risk of a NASH Diagnosis
Of course, over time, a diagnosis of NASH can lead to significant liver scarring (called cirrhosis) and liver failure. Interestingly, the major cause of death in NASH patients is not from the liver but rather cardiovascular events such as heart attack and stroke. That is because the fat is deposited in other organs. Some studies show an 8 fold increase in the relative risk of death from a NASH diagnosis. Also NASH increases risk of cancer by as much as 3 fold.
This risk can be significantly reduced by achieving a normal BMI (body mass index). Obesity can lead to NASH and its many complications (liver scarring, heart attack, stroke and cancer).
The team at GastroIntestinal Specialists, A.M.C. treats multiple conditions and diseases of the gastrointestinal (GI) tract. Our board-certified physicians have more than 150 years of combined experience in providing quality care you can trust. To schedule an appointment, call (318) 631-9121 or visit gis.md.