Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease commonly called nonalcoholic steatohepatitis, simply abbreviated as NASH, is defined as inflammation of a fatty liver that is not caused by alcohol. A fatty liver refers to the accumulation of fat in the liver cells commonly seen in patients with diabetes or obesity or in patients consuming excess alcohol. A fatty liver by itself does not cause any damage to the liver; however, inflammation of a fatty liver can result in scarring (cirrhosis) and malfunction of the liver.

Although the specific cause of NASH is unknown, it is important to understand that NASH is an inflammatory liver disease that is not associated with alcohol or viral hepatitis A, B, or C. NASH is not transmitted from person to person and is not passed on from generation to generation. The exact incidence of NASH is not known. NASH is the most common liver disease in adolescents and the third leading cause of liver disease in adults behind alcohol and hepatitis C. NASH has been reported in up to 9% of all liver biopsies performed. A biopsy refers to tissue obtained from the liver that is examined under a microscope. Although there is no cure for NASH, a small percentage of patients go on to develop liver cirrhosis.

Living With Your Diagnosis

Most patients with NASH are unaware they have the problem because they usually have no symptoms. Some patients may have nonspecific complaints of fatigue, abdominal discomfort, and just not feeling right. On examination, your physician may feel an enlarged liver or spleen, but in general, most patients have no symptoms and no major findings.

Many times your physician may come on this diagnosis accidentally while evaluating another complaint. One common scenario leading to the diagnosis of NASH is the finding of abnormal liver function blood testing. In this case, your physician will proceed with a detailed history, physical examination, and additional workup to exclude common causes of abnormal liver function blood tests, for example, hepatitis A, B, or C; alcohol; hemochromatosis (abnormal accumulation of iron stored in the liver); autoimmune hepatitis; and so forth. In addition, your physician may order special x-ray examinations, an ultrasound (use of sound waves to image internal organs of the body), computed tomography (CT) scan (special x-ray machine that develops high-resolution images of internal organs of the body), or magnetic resonance imaging (MRI) scans (using high-powered magnets to image internal organs of the body).

However, the only definite way to diagnose NASH is by obtaining a liver biopsy. A biopsy requires cutting out a piece of the liver that will be examined under a microscope.

Treatment

At this time there is no specific treatment available for NASH. However, if you are obese, diabetic, or have high cholesterol, it is recommended to lose weight and control your sugars and lipid blood levels through diet, exercise, and nutrition. In some circumstances, your physician may try a medication called ursodeoxycholic acid, which has been shown to improve liver function blood tests and to decrease the fatty accumulation and inflammation of the liver.

The DOs

Do realize that oftentimes a liver biopsy is not performed and the diagnosis of NASH is one of a diagnosis of exclusion. What this means is that your physician will exclude all other possible causes of an inflammatory fatty liver (e.g., alcohol, viral, etc.), and once ruled out then you are left with the diagnosis of NASH.
Do ask your doctor about certain medications that can be harmful to the liver such as acetaminophen, sedatives, and certain medications used in patients with diabetes and high cholesterol.
Do lose weight if you are obese, defined as a body mass index greater than 30 kg/m2.

The DON’Ts

Don’t drink alcohol. Abstaining from alcohol may reverse the accumulation of fat stored in the liver cells.
Don’t forget that some patients with NASH can progress to liver cirrhosis and complications from liver failure, for example, jaundice (yellow skin color), ascites (fluid in and swelling of the abdomen), and leg edema (swelling of the legs).

When to Call Your Doctor

If you have abdominal pain.
If you notice any yellow skin color changes.
If you have leg swelling.
If you notice swelling of the abdomen.
If you need a referral to a gastroenterologist (a physician specializing in diseases of the intestines, gallbladder, pancreas, and liver).

For More Information
American Liver Foundation
75 Maiden Lane, Suite 603
New York, NY 10038
Toll free: 1-800-465-4837