Nonalcoholic Steatohepatitis (NASH)

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NASH is a health condition caused by the buildup of fat in the liver, resulting in liver inflammation and damage. NASH is a further stage of nonalcoholic fatty liver disease (NAFLD). The symptoms are hardly noticed until it gets to the cirrhosis stage, but early signs may be… Treatment of the condition includes the management of obesity and others.

The name was first given by Dr. Ludwig, about 30 years ago, to describe a nonalcoholic fatty liver dysfunction, which leads to inflammation and damage of the liver. 

Healthcare providers categorize fatty liver disease into two forms: nonalcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH) — because of the extremity of this fatty liver disease. 

NAFLD is the most common form of chronic liver disease affecting over 20% of the population in the USA, and a 30% proximity of this class advancing to NASH, with proofs of cirrhosis and liver failure. 


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Nonalcoholic Steatohepatitis (NASH)

Risk Factors Of NASH

  • Type 2 diabetes,
  • Hypothyroidism,
  • Hypopituitarism,
  • Obesity,
  • High cholesterol levels,
  • High-fat levels (triglycerides) in the blood,
  • Sleep apnea (breathing disorder which stops and starts),
  • Metabolic syndrome (high blood sugar, high blood pressure, excess fat, high cholesterol levels),
  • Polycystic ovary syndrome (enlarged ovary with small cysts), 
  • Old age.


  • Lab Tests

Blood tests are done to determine the following:

    1. Blood sugar levels (on fasting blood sugar), 
    2. Complete blood count,
    3. Hemoglobin AIC (to determine the stability of your blood sugar),
    4. Liquid profile,
    5. Liver enzyme and function tests,
    6. Celiac disease screening tests,
    7. Test for hepatitis A, C, and others.
  • Imaging Tests
  1. Abdominal Ultrasound; which is always the first test when NASH is suspected.
  2. Magnetic Resonance Elastography (MRE); which creates a usual map (elastography), showing the stiffness of body tissues.
  3. Transient Elastography; which is the ultrasound that measures the liver stiffness, indicated by fibrosis or scarring.

Treatment Of NASH

The first approach for treating NASH is the management of obesity. Weight loss can be gotten through a combination of a healthy diet and exercise. Your doctor may recommend a weight loss surgery option if you need a great loss of weight. 

Liver implantation remains the best option for patients who develop cirrhosis due to NASH.

Unfortunately, there’s no approved drug treatment by FDA for a nonalcoholic fatty liver disorder, up to date. Intense research is ongoing with promising results. 

With all clinical trials in place, doctors have resorted to this disease by educating their patients on good lifestyle and home remedies. Prominent among these are:

  1. Weight Loss Management: Reduce your calories each day through food choice and physical activities.
  2. Cholesterol Reduction: Through healthy plant-based foods, exercise, and medications.
  3. Taking Healthy Diets: Diets rich in vegetables, fruits, and whole grains. Eggs, fish, and seafood, as well as lean meats, should form your meals.
  4. Be More Active: Exercise, take walks and jog in at early morning hours. Also, increase your home activities.
  5. Control Your Blood Sugar: Fight diabetic conditions via medications and sugar intake.
  6. Avoid alcohol and all alcoholic beverages.
  7. Protect Your Liver: Seek your doctor’s advice on any drug (herbal or orthodox) you take in, and follow all instructions on any over-the-counter drugs medication.
  8. Antioxidants Intake: Vitamin E and other vitamins (antioxidants) can reduce or neutralize the damage caused by inflammation. Seek your doctor’s advice.


  • Weight Loss Surgery

Bariatric surgery affects weight loss by restricting the amount of food in the stomach of obese people. It’s a long-term care procedure, largely achieved by altering gut hormone levels that control hunger and satiety. 

Bariatric surgery is expensive ($20000–$25000) and may take up to 6 weeks.

  • Liver Transplant

This is the surgery that replaced a nonfunctional liver with a healthy one. The healthy liver may be from a deceased donor or a portion of a healthy liver from a living donor. This surgery costs about $160,000 in the best hospitals in India.


As  NASH advances, more complications ensue and need medical attention. It can lead to cirrhosis and liver cancer. Its patients stand high risks of dying from liver-related issues. For example, it culminates into cirrhosis, leading to liver failure which results in death, except by a timely intervention of a liver transplant. 

Some complications following NASH include:

  • Inflammation of the liver,
  • Fibrosis (scarring),
  • Cirrhosis,
  • Ascites,
  • Esophageal varices (vein swelling, later rapture, and esophagus bleeding),
  • Hepatic encephalopathy (drowsiness and slurred speech),
  • Liver cancer,
  • Liver dysfunction/failure.

Mortality Rate

A study presented by the American Drug Administration (ADA) has revealed that patients with both diabetes and NASH/NAFLD have an overall mortality rate of 25.1%. The survival rate of patients with cirrhosis over 5 years was 75.2%. Cirrhosis is the 9th leading cause of death in the USA, accounting for about 1.2% of all US deaths. About 35000 die each year in the USA, of cirrhosis.


NASH and NAFLD do not show signs and symptoms. However, when they do, they may include pain in the upper right abdomen and fatigue. In its advanced stage (cirrhosis), NASH may have the following signs and symptoms:

  • Jaundice (eye and skin yellowing).
  • Reddish palms.
  • Ascites (swollen abdomen).
  • Swollen spleen.
  • General body weakness.


The reason why some accumulated fat in the liver, while others do not, is not yet known. It isn't clear why some fatty livers develop inflammation which leads to total liver collapse. 

However, NASH is believed to be associated with the following:

  • Obesity.
  • High-fat concentration in the blood.
  • Metabolic dysfunction (in which body cells resist insulin which in turn, hinders the absorption of sugar into cells).
  • Hyperglycemia (high sugar level due to no absorption)


  • Is NASH reversible?

There's no medication to reverse the fat buildup in the liver. While in some cases, the liver damage may correct itself, but in others, it continues to progress to cirrhosis and liver failure. If you have NASH, you should control any condition that may contribute to fatty deposits in your liver. Avoid high calorie and high cholesterol diets.

  • How do I cleanse my liver?

The following methods are ways to clean and maintain a healthy liver:

    1. Eat more prebiotics; yogurt, kimchi, sauerkraut, miso, kombucha, tempeh, bananas, etc.
    2. Eat antioxidant-rich foods.
    3. Reduce your sugar intake.
    4. Eat less processed and canned foods.
    5. Reduce the amount of salt in your foods.
    6. Reduce alcohol or alcoholic beverages intake. 
    7. Drink much water and fluids.
    8. Have enough sleep.
    9. Be more active and exercise.


  • Is coffee intake food with fatty liver?

Coffee is a rich source of disease-fighting antioxidants. It is one of the best beverages you can drink to improve moods, stop headaches, reduce the risk of liver cancer, cirrhosis of the liver, type2 diabetes, etc. Taking two or more cups of coffee a day may influence liver damage.

  • With NASH, what foods should form my meals, and what should not?

Foods to take:

    1. Low-glycemic index foods (most fruits, vegetables, whole grains, and olive oil).
    2. Fruits, like berries, grapefruits, grapes, prickly pear, and bananas.
    3. Prebiotics; yogurt, kimchi, sauerkraut, miso, kombucha, tempeh, bananas, etc.
    4. Nuts.
    5. Fatty fish, seafood, lean meats, honey, eggs.
    6. Coffee, tea, and other antioxidant-rich foods.
    7. Much water and fluids.

Foods not to take:

    1. Alcohol and alcoholic beverages.
    2. High-calorie foods; fried foods, fats, and oils.
    3. Sugary foods.
    4. Much salt.
    5. Red meat.
    6. White bread.
    7. Rice and pasta.
  • Who are the high-risk groups for nonalcoholic steatohepatitis?

The following groups have a high risk of developing the condition:


  • The elderly.
  • Diabetic patients.
  • Alcoholic and drug addicts.
  • The obese.
  • Sleep apnea (breathing disorder) patients.
  • Underactive thyroid patients.
  • Underactive pituitary gland patients.
  • People with high cholesterol and fat levels.
  • People with high blood pressure and high blood glucose.
  • Patients of the polycystic ovary syndrome.