Understanding Nonalcoholic Steatohepatitis (NASH): Key Points to Remember

Non-Alcoholic Steatohepatitis (NASH) is a serious form of non-alcohol-related fatty liver disease that affects millions worldwide. This condition, which involves the accumulation of fat and inflammation in the liver, can lead to fibrosis and, potentially, liver failure.

NASH may result from metabolic syndrome, a set of risk factors for heart disease and type 2 diabetes. Signs of metabolic syndrome can include high blood pressure, blood glucose levels that are insufficiently controlled, higher proportions of body fat, and unhealthy cholesterol levels.

The stages of NASH include mild, moderate, severe, and cirrhosis. In the initial stage, fat accumulation is accompanied by inflammation, marking the beginning of NASH. Over time, fibrosis can worsen and lead to cirrhosis, increasing the risk of liver failure.

For the treatment of NASH, lifestyle and diet changes are the most effective approach. The primary recommended lifestyle and dietary changes focus on achieving gradual weight loss (5-10% of body weight) and adopting a liver-friendly diet similar to the Mediterranean diet. Key dietary recommendations include eating plenty of vegetables, fruits, whole grains, lean proteins (fish, chicken, legumes), and healthy fats (nuts, seeds, olive oil, omega-3 rich fish), while avoiding sugary drinks, refined carbohydrates, fried and highly processed foods, and limiting red and processed meats. Regular moderate exercise—at least 150 minutes per week combining aerobic and resistance training—is also advised to improve liver health and insulin sensitivity.

Weight loss should be gradual (about 0.5 to 1 kg per week), sustainable, and ideally supervised by healthcare professionals to avoid worsening liver injury. The Mediterranean diet is recommended because it emphasizes plant-based foods, healthy fats, and lean proteins, which help reduce liver fat and inflammation. Foods to avoid or limit include sugary beverages, refined carbs like white bread and pastries, fried foods, processed meats, and excess red meat. Drinking plenty of water and certain beverages like coffee, green tea, and lemon juice may benefit liver metabolism and health.

Supplements such as milk thistle and turmeric have some evidence of benefit in reducing liver inflammation, but these should be considered adjuncts rather than primary treatments. Doctors may also recommend vitamin E supplements to reduce inflammation in the liver.

Obesity is another risk factor for NASH, affecting over 90% of people with obesity. A sedentary lifestyle and unhealthy diet can increase the chances of NASH developing.

Heart disease was the most common cause of death in people with non-alcohol-related fatty liver disease, making up of cases in a 2015 report. People with NASH may experience vague discomfort or stiffness in the upper-right area of their abdomen or other general symptoms, such as fatigue.

Doctors may perform multiple biopsies and use imaging tests like ultrasounds or MRIs to identify the severity of non-alcohol-related fatty liver disease. Doctors can use various methods to identify the severity of NASH or specifically. Anyone with symptoms of a metabolic disorder, multiple risk factors, or a family history of NASH or metabolic syndrome should receive a risk assessment and possibly tests to check their liver health.

Without treatment, NASH can lead to liver failure and death. However, making lifestyle changes and managing other health conditions can improve the outlook. It's crucial for anyone with concerns about their liver health to consult a healthcare professional for a proper assessment and guidance.

NASH, a form of non-alcohol-related fatty liver disease, can lead to liver failure if left untreated, given its potential to cause fibrosis.
Metabolic syndrome, a set of risk factors for heart disease and type 2 diabetes, can contribute to the development of NASH.
Lifestyle and diet changes are the most effective approach to treating NASH, with a gradual weight loss of 5-10% of body weight as the primary goal.
The Mediterranean diet, emphasizing plant-based foods, healthy fats, and lean proteins, is recommended for managing liver fat and inflammation in NASH.
Regular moderate exercise, combining aerobic and resistance training, is crucial for improving liver health and insulin sensitivity.
Beyond lifestyle changes, supplements like milk thistle and turmeric, and vitamin E may help reduce liver inflammation, but should be used as adjuncts rather than primary treatments.