What is NASH?
Nonalcoholic steatohepatitis (NASH) is is a condition characterized by inflammation and the
accumulation of fat and fibrous tissue in the liver. NASH is part of nonalcoholic fatty liver diseases, in
which fat builds up in the liver and sometimes causes liver damage that gets worse over time
(progressive liver damage). NASH occurs in those who do drink little to no alcohol.
Although the exact cause is not known, NASH seems to be related to certain other conditions including
diabetes obesity, high cholesterol and triglycerides.

Symptoms
Patients may have no symptoms in the early stages of NASH. Most people with NASH feel well and
only begin to have symptoms when the disease progresses. Symptoms may develop, including:
• Fatigue.
• Unexplained weight loss.
• General weakness.
• An aching in the upper stomach area.
• Confusion or trouble thinking.
It may take years for NASH to become severe. In some cases, the progress can stop and even reverse
on its own without treatment. Otherwise, NASH can slowly get worse and cause scarring or fibrosis of
the liver. If this happens, you may have other symptoms such as:
• Fluid buildup in your legs and abdomen.
• Yellowing of your skin (jaundice).
• Nausea.
• Nosebleeds.
• Blood in your stool.
• Bruising easily.
• Weight loss and muscle loss.
• Abdominal pain.
• Frequent infections.

Causes
The exact cause of NASH is not known. NASH most often occurs in people who are middle-aged and
overweight or obese, many of whom have high cholesterol and triglycerides, or diabets. However, it can
also occur in people without these risk factors. If you have NASH and diabetes, your insulin levels
may be even higher than if you had diabetes alone.
Many things can lead to the buildup of fat in the liver. The fat may come from another part of your
body or from an increase in the amount of fat that reaches your liver from your intestines. An increase
in fat in your diet alone will not cause fatty liver disease.
Several factors may contribute to liver damage from NASH, including:
• Resistance to insulin -- your body can’t digest sugar (glucose) as normal.
• Changes in how the liver makes fat and deals with fat that is delivered to it by the intestines.
• The release of toxic substances by fat cells.
• The breakdown of liver cells.
• Certain drugs, including amiodarone, tamoxifen and so on
• Using a feeding tube or other method of receiving nutrition for a long time.
• Alcohol.

Diagnosis
NASH will be diagnosed when abnormality in liver tests that are included in routine blood test panels,
such as ALT or AST. When further evaluation shows no possibilities for liver disease (such as
medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver
show fat, NASH is suspected. The liver biopsy is the only method of proving a diagnosis of NASH
and separating it from simple fatty liver. When examination of the tissue with a microscope shows fat
along with inflammation and damage to liver cells, NASH is diagnosed. If not, simple fatty liver or
NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue
has developed in the liver

Treatment and prevention
Currently, there is no specific treatment for NASH. The most important recommendations given to
persons with this disease are to:
• lose excessive weight
• follow a balanced and healthy diet
• more physical activity
• avoid alcohol
• avoid unnecessary medications
A major attempt should be made to lower body weight to normal level. Weight loss can improve liver
tests in patients with NASH. People with NASH often have other medical conditions, such as diabetes,
high blood pressure, or elevated cholesterol. These conditions should be treated with medication and
adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating
these other conditions.
To prevent fat from building up in your liver is a effective prevention of NASH. A healthy lifestyle
includes regular exercise and a healthy diet which can decrease your body's resistance to insulin.
If you have diabetes, keep your blood sugar in a safe range.
If you already have NASH or if tests have shown that fat has already built up in your liver, modifying
your diet and getting regular exercise can help reduce the risk of further liver damage. You should also
avoid alcohol and any medicines that may harm the liver.