Nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis

Description, Causes and Risk Factors:

Abbreviation: NASH.

Nonalcoholic steatohepatitis is a condition that causes inflammation and accumulation of fat and fibrous tissue in the liver. The exact cause of nonalcoholic steatohepatitis is unknown. However, it is seen more frequently in people with certain medical conditions such as diabetes, obesity, and insulin resistance. This combination of disorders if often called the metabolic syndrome.

It is not clear how many people have NASH because it causes no symptoms. However, NASH is diagnosed in about 7 to 9 percent of people in the United States who have a liver biopsy. Most people are between the ages of 40 and 60 years, although the condition can also occur in children over the age of 10 years. NASH is seen more often in women than in men.

Although the cause of NASH is unknown, it is most frequently seen in people with one of more of the following conditions.

Possible risk factors:

    Obesity — More than 70 percent of people with NASH are obese. Most obese people with NASH are between 10 and 40 percent heavier than their ideal body weight.

  • Diabetes — Up to 75 percent of people with NASH have type 2 diabetes.

  • Hyperlipidemia — About 20 to 80 percent of people with NASH have hyperlipidemia (high blood triglyceride levels and/or high blood cholesterol levels).

  • Insulin resistance — Insulin resistance refers to a state in which the body does not respond adequately to insulin. Insulin resistance often occurs in people with hyperlipidemia who are obese; this group of symptoms is known as the metabolic syndrome and is frequently seen in people with NASH.

  • Drugs and toxins — Several drugs used to treat medical conditions have been linked to NASH.

India may have the largest number diabetics in the world, but not many studies on NASH are there in India till now. In a small epidemiological study among healthy controls (relatives of accompanying patients), prevalence of fatty liver in absence of alcohol intake (by imaging modality) was 24% and was more prevalent in men compared to women. NASH has been demonstrated to be higher among chronic liver disease (CLD) with diabetes than in those without. Among patients of NASH from India, 50-70% had one of the 3 risk factors viz. diabetes, obesity and hyperlipidemia. Mean age of patients was 35-55 years and there was a predominance of men than women. NASH constitutes around 6% of all chronic hepatitis cases.


You may have no symptoms in the early stages of NASH. Most people who have NASH feel fine and do not know that they have it.As NASH progresses and liver damage gets worse, you may start to have symptoms such as:

    Fatigue and lethargy.

  • Weight loss for no clear reason.

  • General weakness.

  • An ache in the upper right part of your belly.

Most have mild-to-moderate elevations of serumaminotransferase levels, which are typically less thanfour times the upper limit of normal in contrast toalcoholic hepatitis, NASH is typically associated withan ALT level greater than the AST level in the absenceof cirrhosis.Although aminotransferase elevations areused to diagnose NASH, these lack adequate sensitivityto detect patients with NASH and are entirelynonspecific in predicting liver injury.


No single test can diagnose NASH. Your doctor will ask you about other health problems you have had.To see if fat is building up in your liver and to rule out other diseases, your doctor may do tests such as:

    An abdominal ultrasound.

  • A CT scan.

  • An MRI scan.

Liver biopsy: Your doctor may also do a liver biopsy to be sure that you have NASH. In a liver biopsy, your doctor takes a sample of tissue from your liver and checks it for signs of NASH.


There is no known treatment for NASH. But you may be able to limit damage to your liver by managing conditions that increase your risk for NASH or make it worse. You can:

    Reduce your total cholesterol level.

  • Reach a healthy weight. If you need to lose weight, be sure to do so slowly (no more than 1 to 2 pounds a week).

  • Quick weight loss from crash diets, surgery, or medicine increases inflammation and scarring in your liver.

  • Control diabetes.

  • Stop or cut back on drinking alcohol.

  • Exercise regularly.

Many patients of NASH who developed chronic liver disease have undergone liver transplantation. Re-development of NASH in such patients in the new donor liver occurs in 2/3rd and in 1/3rd to speculation that orthoptic liver transplantation is unsuccessful in NASH patients and hence NASH is considered to be a relative contra-indication to liver transplantation. Significant fibrosis occurs within one year.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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