What is NASH?

NASH stands for Non-Alcoholic SteatoHepatitis. It can be defined as the liver manifestation of a metabolic disorder, and is the most severe form of non-alcoholic fatty liver disease (NAFLD). NASH is closely related to the triple epidemic of obesity, pre-diabetes, and diabetes1 But its symptoms are often silent or non-specific to NASH, making it difficult to diagnose. As a result, NASH patients can remain unaware of their condition until late stages of the disease.2,3

WHAT IS NAFLD?

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term that encompasses the entire spectrum of fatty liver disease, from isolated steatosis to NASH.4

LEARN HOW NASH IS DIAGNOSED

A MODERN LIFESTYLE DISEASE

NASH is heavily influenced by lifestyle (e.g., chronic excessive calorie intake, sedentary activity) and is distinct from other fatty liver diseases caused by alcohol abuse or medication side effects.1

RISK FACTORS

The symptoms of NASH are often invisible until the liver is damaged beyond repair.42,3 But understanding the risk factors for NASH can help at-risk patients get the right diagnosis.

Hypertension

Heart Disease

High Blood Lipids Levels

Insulin Resistance

Type 2
Diabetes

Obesity

WHO IS AT RISK FOR NASH?5

A PROGRESSIVE & LIFE-THREATENING DISEASE

NASH worsens the cardiometabolic condition of patients, and is related to higher risk of death caused by cardiovascular events.1 Up to 38% of deaths in patients with NASH are directly related to cardiovascular events.6

While patients remain unaware of their liver condition, NASH can progress to more serious disease stages, such as advanced fibrosis, cirrhosis, liver failure, or liver cancer, driven by hepatocellular ballooning and inflammation.4

In advanced stages of the disease, liver transplant may be a patient’s only option.1 But this risky surgical procedure is associated with various complications, not to mention long waiting lists due to the lack of available healthy organs from donors, or eligibility issues related to patient condition.

Healthy liver

The liver is the largest solid organ in the body and it performs many essential functions, such as nutrient metabolism, protein synthesis, bile production, and glycogen storage. A healthy liver is blood-red with a smooth surface and contains 5% (or less) fat.1

Steatosis

Fatty liver, or non-alcoholic hepatic steatosis, is observed in individuals who chronically consume excess calories and/or have a sedentary lifestyle, in the absence of significant alcohol consumption. Excess calories are stored in liver cells as lipids, resulting in a liver with fat content above 5% and a pale yellow color.1

NASH

After enough excess fat has accumulated in the liver, chronic inflammation and cell death (ballooning) result in NASH. At this stage, patients have a higher risk of death from cardiovascular disease.1

Cirrhosis

Chronic and continuous cell damage and ballooning result in the formation of fibrous scar tissue (fibrosis). Eventually, excessive scar formation will result in loss of liver function, a state known as cirrhosis or stage 4 fibrosis.1

Outcomes

Patients with NASH-related cirrhosis are at higher risk of end-stage liver diseases, such as loss of liver function (decompensation), liver failure, and hepatocellular carcinoma (liver cancer). They are also at higher risk of death from cardiovascular disease and non-liver cancer.1

HOW PREVALENT IS NASH?

References

NASH stands for Non-Alcoholic SteatoHepatitis. It can be defined as the liver manifestation of a metabolic disorder, and is the most severe form of non-alcoholic fatty liver disease (NAFLD). NASH is closely related to the triple epidemic of obesity, pre-diabetes, and diabetes.1 But its symptoms are often silent or non-specific to NASH, making it difficult to diagnose. As a result, NASH patients can remain unaware of their condition until late stages of the disease.2,3

WHAT IS NAFLD?

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term that encompasses the entire spectrum of fatty liver disease, from isolated steatosis to NASH.4

LEARN HOW NASH IS DIAGNOSED

A MODERN LIFESTYLE DISEASE

NASH is heavily influenced by lifestyle (e.g., chronic excessive calorie intake, sedentary activity) and is distinct from other fatty liver diseases caused by alcohol abuse or medication side effects.1

RISK FACTORS

The symptoms of NASH are often invisible until the liver is damaged beyond repair.2,3 But understanding the risk factors for NASH can help at-risk patients get the right diagnosis.

Hypertension

Heart Disease

High Blood Lipids Levels

Insulin Resistance

Reference

  1. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol, 2016;64(6):1388-1402. ↩︎
  2. Mayo Clinic. Nonalcoholic fatty liver disease. https://www.mayoclinic.org/diseases-
    conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567?p=1. Accessed October 7, 2019. ↩︎
  3. Polis S, Fernandez R. Impact of physical and psychological factors on health-related quality of life in adult patients with liver cirrhosis: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(1)39-51. ↩︎
  4. ↩︎