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Non-alcoholic Steatohepatitis (NASH)

What is Non-alcoholic Steatohepatitis (NASH)?

Nonalcoholic steatohepatitis (NASH) is a condition where there is fat accumulation and inflammation in the liver. NASH occurs in people who do not drink alcohol.

The exact cause of NASH is unknown, however it is seen with increased frequency in people with certain medical conditions such as diabetes mellitus, obesity and high cholesterol.

NASH is typically a chronic condition that persists for many years. Most people with this condition will not develop serious liver problems. On the other hand, the condition can lead to progressive scarring and cirrhosis in others. It is difficult to predict the natural course of NASH in individual patients.


Most people with NASH have no symptoms. The condition is usually picked up during routine health screening when liver function test results are found to be abnormal.

Who are at risk for NASH?

Those who are overweight (BMI exceeds 23 for Asians and 25 for Caucasians). Those with diabetes mellitus, gout, hypertension and hyperlipidemia are at risk of developing NASH.

How do you diagnose NASH?

Liver function tests usually show an elevated ALT or AST. Fatty infiltration of the liver is also seen on ultrasound of the abdomen. It is important to exclude viral hepatitis B and C, as well as other metabolic and autoimmune causes of liver disease through blood tests.

The most accurate test for the diagnosis of NASH is a liver biopsy. The biopsy will also help to determine the stage of the disease (i.e. whether cirrhosis is present).

What is the treatment for NASH?

At this time, there are no treatments that can cure NASH. The main goal of treatment is to control the conditions that are associated with NASH, such as obesity and hyperlipidaemia. Several experimental treatments are being studied, but none can be routinely recommended at this time of this writing.

Lifestyle measures such as weight reduction are the main stay of treatment but should be done gradually as rapid weight loss has been associated with worsening of liver disease.

What is the prognosis for patients with NASH?

The typical course of NASH is still being studied. About a third may progress to fibrosis and about 20% will develop cirrhosis over a period of 9 years.

Normal liver biopsy
Picture of normal liver biopsy

NASH liver biopsy
Picture of NASH liver biopsy

When to seek medical advice

A liver doctor (hepatologist) can conduct a diagnosis and also advise on how to manage the condition.

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