NASH, or nonalcoholic steatohepatitis, is a severe form of nonalcoholic fatty liver disease marked by liver inflammation and damage due to excessive fat accumulation. It is associated with a higher risk of cirrhosis, liver cancer, liver failure, cardiovascular disease, and increased mortality.
What is NASH?
NASH is a severe and aggressive type of nonalcoholic fatty liver disease (NAFLD) characterized by inflammation (hepatitis) and damage to the liver caused by excessive fat accumulation. NASH is associated with an increased risk of cirrhosis, liver cancer, liver failure, cardiovascular disease, and mortality.[1]
What are the main signs and symptoms of NASH?
The majority of people with NASH exhibit no signs or symptoms. As NASH progresses and becomes more severe, people may experience vague symptoms, such as fatigue, weakness, or right upper quadrant abdominal pain. Blood tests may reveal elevated liver enzymes, but this isn’t found in all people with NASH.[2]
How is NASH diagnosed?
The gold standard for diagnosing NASH is through a liver biopsy, but this procedure is reserved for people at risk of advanced liver fibrosis. There’s no standard screening for NAFLD, so It’s more common for NASH to be diagnosed incidentally when being assessed for other health conditions. Imaging — specifically, an ultrasound, computed tomography (CT) scans, or certain types of magnetic resonance imaging (MRI) techniques — may be also used to look for signs of fat accumulation in the liver.[2][3]
What are some of the main medical treatments for NASH?
The main approach to managing NASH is weight loss, usually achieved via diet and exercise. Although no standard medications or treatments are approved for NASH, medications are prescribed to manage overall cardiometabolic risk from other comorbid conditions such as diabetes, hyperlipidemia or cardiovascular disease. In severe cases, liver transplantation may be needed if NASH has progressed to end stage liver disease.[2][4]
Hepatitis A and Hepatitis B vaccinations in unvaccinated individuals would reduce the risk of additional liver damage.
How could diet affect NASH?
Weight loss through a hypocaloric diet and lifestyle changes is recommended to manage other factors that contribute to the disease (e.g., obesity) and to prevent further complications (e.g., cirrhosis). Losing 5% or more of body weight can help reduce liver fat, losing 7% or more of body weight can lead to the resolution of NASH, and losing 10% or more of body weight can stabilize or regress fibrosis. It is also recommended that people with NASH reduce their consumption of saturated fat (particularly from processed red meat), commercially produced fructose, and alcohol consumption.[8]
Although there are fewer data on other dietary strategies for treating NASH, such as a low-carbohydrate/high-protein diet or intermittent fasting, these dietary strategies may be helpful if people find them easier to follow while still maintaining a caloric deficit.
Coffee consumption has been associated with a reduced risk of progression to cirrhosis in patients with NASH.[9]
Are there any other treatments for NASH?
Regular physical activity and exercise are recommended for people with NASH, to promote weight loss, reduce liver fat and improve overall health. When diet and exercise are insufficient to manage obesity in persons with NASH, then obesity pharmacotherapy and bariatric surgery might be considered.[4]
What causes NASH?
NASH results from excessive fat buildup in the liver which surpasses its capacity for secretion or metabolism, leading to liver damage and inflammation. This excess fat accumulation, also known as steatosis, is caused by an imbalance between energy intake and expenditure, with more energy consumed than expended.[10] People with obesity, metabolic syndrome, and type 2 diabetes are at the highest risk of developing NAFLD, which can then progress to NASH.[4]
Examine Database: Nonalcoholic Steatohepatitis (NASH)
Research FeedRead all studies
Can Vitamin E improve nonalcoholic steatohepatitis?
In this 96-week randomized controlled trial in participants with nonalcoholic steatohepatitis, taking a vitamin E supplement improved liver health.
Synbiotics may improve cardiometabolic parameters in adults with NAFLD
Vitamin E for nonalcoholic fatty liver disease
Does curcumin improve liver fibrosis?
Does a probiotic improve clinical outcomes in nonalcoholic steatohepatitis?
Frequently asked questions
What is NASH?
NASH is a severe and aggressive type of nonalcoholic fatty liver disease (NAFLD) characterized by inflammation (hepatitis) and damage to the liver caused by excessive fat accumulation. NASH is associated with an increased risk of cirrhosis, liver cancer, liver failure, cardiovascular disease, and mortality.[1]
How are NAFLD and NASH different?
Quick answer:
Nonalcoholic fatty liver disease (NAFLD) encompasses a range of liver conditions that are characterized by fat accumulation without excessive alcohol consumption, whereas nonalcoholic steatohepatitis (NASH) is a more severe form of NAFLD that includes inflammation, cellular damage, and potential fibrosis. Approximately 20% of people with NAFLD develop NASH, which is considered a progressive stage of the disease.
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are related, yet distinct, terms. NAFLD refers to a spectrum of liver diseases characterized by excess fat stored in the liver without excessive alcohol consumption or other secondary causes of fatty liver disease. Clinically, NAFLD is categorized as either simple fatty liver (NAFL) in which excess fat accumulation has occurred, but there is no evidence of cellular damage, or NASH, in which, in addition to the excess fat accumulation, inflammation of the liver (hepatitis), cellular damage (i.e., hepatocyte ballooning), and perhaps structural changes such as fibrosis are present. NASH occurs in about 20%[11] of people with NAFLD and is often thought of as the progressive form of NAFLD. We summarize how a healthy liver progresses through these steps in Figure 3.
What are the main signs and symptoms of NASH?
Most people with nonalcoholic steatohepatitis (NASH) show no signs or symptoms, but as the condition worsens, they may experience vague symptoms like fatigue, weakness, or abdominal pain. Elevated liver enzymes may be detected in blood tests, although this is not universal among people with NASH.
The majority of people with NASH exhibit no signs or symptoms. As NASH progresses and becomes more severe, people may experience vague symptoms, such as fatigue, weakness, or right upper quadrant abdominal pain. Blood tests may reveal elevated liver enzymes, but this isn’t found in all people with NASH.[2]
How is NASH diagnosed?
Nonalcoholic steatohepatitis (NASH) is primarily diagnosed through a liver biopsy, particularly in people who are at risk of advanced liver fibrosis; however, it is often identified incidentally during evaluations for other health issues. Imaging techniques such as ultrasound, CT scans, or specific MRI methods may also be used to detect fat accumulation in the liver.
The gold standard for diagnosing NASH is through a liver biopsy, but this procedure is reserved for people at risk of advanced liver fibrosis. There’s no standard screening for NAFLD, so It’s more common for NASH to be diagnosed incidentally when being assessed for other health conditions. Imaging — specifically, an ultrasound, computed tomography (CT) scans, or certain types of magnetic resonance imaging (MRI) techniques — may be also used to look for signs of fat accumulation in the liver.[2][3]
What are some of the main medical treatments for NASH?
The primary treatment for nonalcoholic steatohepatitis (NASH) is weight loss through diet and exercise because there are no approved medications specifically for NASH. In severe cases, liver transplantation may be necessary, and vaccinations for hepatitis A and B can help reduce the risk of further liver damage.
The main approach to managing NASH is weight loss, usually achieved via diet and exercise. Although no standard medications or treatments are approved for NASH, medications are prescribed to manage overall cardiometabolic risk from other comorbid conditions such as diabetes, hyperlipidemia or cardiovascular disease. In severe cases, liver transplantation may be needed if NASH has progressed to end stage liver disease.[2][4]
Hepatitis A and Hepatitis B vaccinations in unvaccinated individuals would reduce the risk of additional liver damage.
Can NASH be reversed?
Quick answer:
Nonalcoholic steatohepatitis (NASH) can be partially reversed through diet and lifestyle changes, particularly weight loss, which improves liver function and reduces inflammation. However, if untreated, NASH may progress to irreversible liver damage, which makes early detection and intervention crucial.
NASH can be reversible to some extent, depending on the severity of the damage. Making diet and lifestyle changes can improve liver function and reduce inflammation. Weight loss, in particular, has proven to be effective in reducing liver fat and reversing NASH.
If left untreated, NASH can progress to advanced liver disease, such as cirrhosis, where the liver may lose its function and the damage can become irreversible. Early detection and treatment are therefore essential to prevent complications associated with NASH.[1][2]
Have any supplements been studied for NASH?
Several supplements have been studied for the treatment of nonalcoholic steatohepatitis (NASH), including vitamin E, L-carnitine, betaine, melatonin, silymarin from milk thistle, and various probiotic combinations.
How could diet affect NASH?
Diet plays a crucial role in managing nonalcoholic steatohepatitis (NASH) by promoting weight loss through a hypocaloric diet, which can reduce liver fat and potentially resolve the condition. Additionally, reducing saturated fat, fructose, and alcohol intake, along with considering other dietary strategies like low-carbohydrate diets or intermittent fasting, may also be beneficial.
Weight loss through a hypocaloric diet and lifestyle changes is recommended to manage other factors that contribute to the disease (e.g., obesity) and to prevent further complications (e.g., cirrhosis). Losing 5% or more of body weight can help reduce liver fat, losing 7% or more of body weight can lead to the resolution of NASH, and losing 10% or more of body weight can stabilize or regress fibrosis. It is also recommended that people with NASH reduce their consumption of saturated fat (particularly from processed red meat), commercially produced fructose, and alcohol consumption.[8]
Although there are fewer data on other dietary strategies for treating NASH, such as a low-carbohydrate/high-protein diet or intermittent fasting, these dietary strategies may be helpful if people find them easier to follow while still maintaining a caloric deficit.
Coffee consumption has been associated with a reduced risk of progression to cirrhosis in patients with NASH.[9]
Are there any other treatments for NASH?
Regular physical activity and exercise are recommended for people with nonalcoholic steatohepatitis to aid in weight loss and improve liver health. If diet and exercise alone are not effective, obesity pharmacotherapy and bariatric surgery may be options to consider.
Regular physical activity and exercise are recommended for people with NASH, to promote weight loss, reduce liver fat and improve overall health. When diet and exercise are insufficient to manage obesity in persons with NASH, then obesity pharmacotherapy and bariatric surgery might be considered.[4]
Is weight loss surgery an effective treatment for NASH?
Quick answer:
Weight loss surgery can help reduce liver fat and damage in people with nonalcoholic steatohepatitis, particularly those with moderate to severe obesity or other health issues like type 2 diabetes. However, due to the risks of complications, it is not recommended as a standalone treatment and should be avoided in people with decompensated liver cirrhosis.
Although weight loss surgery (bariatric surgery) can be beneficial in reducing liver fat and damage, and in decreasing the risk of further health complications, it is typically not recommended as a standalone treatment for NASH. Instead, it may be indicated in individuals with NASH with moderate to severe (Class II or Class III) obesity and/or those who have other cardiometabolic comorbidities such as type 2 diabetes.
Weight loss surgery is not recommended for people with decompensated liver cirrhosis, as it can increase the risk for postoperative complications and mortality.[1][2]
What causes NASH?
Nonalcoholic steatohepatitis is caused by excessive fat buildup in the liver due to an imbalance between energy intake and expenditure and leads to liver damage and inflammation. People with obesity, metabolic syndrome, and type 2 diabetes are at the highest risk of developing this condition.
NASH results from excessive fat buildup in the liver which surpasses its capacity for secretion or metabolism, leading to liver damage and inflammation. This excess fat accumulation, also known as steatosis, is caused by an imbalance between energy intake and expenditure, with more energy consumed than expended.[10] People with obesity, metabolic syndrome, and type 2 diabetes are at the highest risk of developing NAFLD, which can then progress to NASH.[4]
References
Examine Database References
- Ghrelin - Gonciarz M, Bielański W, Partyka R, Brzozowski T, Konturek PC, Eszyk J, Celiński K, Reiter RJ, Konturek SJPlasma insulin, leptin, adiponectin, resistin, ghrelin, and melatonin in nonalcoholic steatohepatitis patients treated with melatoninJ Pineal Res.(2012 Jun 13)
- Liver Enzymes - Chitapanarux T, Tienboon P, Pojchamarnwiputh S, Leelarungrayub DOpen-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patientsJ Gastroenterol Hepatol.(2009 Jun)
- Liver Enzymes - T Hasegawa, M Yoneda, K Nakamura, I Makino, A TeranoPlasma transforming growth factor-beta1 level and efficacy of alpha-tocopherol in patients with non-alcoholic steatohepatitis: a pilot studyAliment Pharmacol Ther.(2001 Oct)
- Liver Enzymes - Sumida Y, Naito Y, Tanaka S, Sakai K, Inada Y, Taketani H, Kanemasa K, Yasui K, Itoh Y, Okanoue T, Yoshikawa TLong-term (>=2 yr) efficacy of vitamin E for non-alcoholic steatohepatitisHepatogastroenterology.(2013 Sep)
- Liver Enzymes - Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, Neuschwander-Tetri BA, Lavine JE, Tonascia J, Unalp A, Van Natta M, Clark J, Brunt EM, Kleiner DE, Hoofnagle JH, Robuck PR, NASH CRNPioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitisN Engl J Med.(2010 May 6)
- Liver Enzymes - Miwa Kawanaka, Sabina Mahmood, Gouichi Niiyama, Akiyoshi Izumi, Ayumi Kamei, Hideji Ikeda, Mitsuhiko Suehiro, Kazumi Togawa, Takayo Sasagawa, Misako Okita, Hajime Nakamura, Junji Yodoi, Gotaro YamadaControl of oxidative stress and reduction in biochemical markers by Vitamin E treatment in patients with nonalcoholic steatohepatitis: a pilot studyHepatology Research.()
- Liver Enzymes - Chee NM, Sinnanaidu RP, Chan WKVitamin E improves serum markers and histology in adults with metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis.J Gastroenterol Hepatol.(2024 Aug 16)
- Liver Enzymes - Abdelmalek MF, Angulo P, Jorgensen RA, Sylvestre PB, Lindor KDBetaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot studyAm J Gastroenterol.(2001 Sep)
- Liver Enzymes - Sandeep Mukherjee, Tamara Bernard, Kusum Kharbanda, Anthony J. Barak, Michael F. Sorrell, Dean J. TumaImpact of Betaine on Hepatic Fibrosis and Homocysteine in Nonalcoholic Steatohepatitis - A Prospective, Cohort StudyThe Open Translational Medicine Journal.()
- Liver Enzymes - Zhong S, Fan Y, Yan Q, Fan X, Wu B, Han Y, Zhang Y, Chen Y, Zhang H, Niu JThe therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trialsMedicine (Baltimore).(2017 Dec)
- Liver Enzymes - de Avelar CR, Pereira EM, de Farias Costa PR, de Jesus RP, de Oliveira LPMEffect of silymarin on biochemical indicators in patients with liver disease: Systematic review with meta-analysis.World J Gastroenterol.(2017-Jul-21)
- Liver Enzymes - Malaguarnera M, Gargante MP, Russo C, Antic T, Vacante M, Malaguarnera M, Avitabile T, Li Volti G, Galvano FL-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trialAm J Gastroenterol.(2010 Jun)
- Weight - Amiri-Moghadam S, et alEffects of L-carnitine supplementation on body composition in patients with nonalcoholic steatohepatitis (NASH)CURR TOP NUTRACEUT R.()
- Oxidative Stress Biomarkers - Amiri-Moghadam s, et alEffects of L-carnitine supplementation on inflammatory factors and malondialdehyde in patients with nonalcoholic steatohepatitis (NASH)CURR TOP NUTRACEUT R.()
- Liver Enzymes - Jingwen Zhou, Yidi Chen, Jun Yu, Tianci Li, Ziyu Lu, Yan Chen, Xiaolong Zhang, Fang YeThe efficacy of novel metabolic targeted agents and natural plant drugs for nonalcoholic fatty liver disease treatment: A PRISMA-compliant network meta-analysis of randomized controlled trialsMedicine (Baltimore).(2021 Mar 26)
- Liver Enzymes - Musazadeh V, Assadian K, Rajabi F, Faghfouri AH, Soleymani Y, Kavyani Z, Najafiyan BThe effect of synbiotics on liver enzymes, obesity indices, blood pressure, lipid profile, and inflammation in patients with non-alcoholic fatty liver: A systematic review and meta-analysis of randomized controlled trials.Pharmacol Res.(2024 Sep 4)