Non-Alcoholic Steatohepatitis (NASH) is liver inflammation due to fat buildup in the liver. The Department of Hepato-pancreato-biliary and Transplant Surgery at Singapore General Hospital shares how it is diagnosed and gives prevention tips.
Non-alcoholic steatohepatitis (NASH) - inflammation of the liver even with little to no alcohol intake
Most people with fatty liver have no or minimal symptoms. Fat build-up in the liver is thought to be common, and is associated with certain metabolic disorders such as diabetes. This can occur regardless of whether one consumes alcohol. In such cases, it is termed Non-Alcoholic Fatty Liver Disease (NAFLD). NAFLD can progress to cause liver inflammation and this condition is known as Non-Alcoholic Steatohepatitis (NASH).
When NASH becomes severe, resulting in scarring of the liver, it can lead to cirrhosis – a potentially life-threatening liver condition that could progress to liver failure and is associated with internal bleeding and coma.
Doctors are uncertain why NAFLD may progress to NASH even in people who drink little or no alcohol. However, they suspect that environmental factors could trigger the inflammation, or there may be a genetic predisposition.
“While the causes of NASH are still unknown, many conditions that cause NAFLD can increase your risk. These include obesity, type 2 diabetes, high cholesterol and high triglycerides, a type of fat found in the blood. Even taking certain medications, such as corticosteroids, can play a role,” says Dr Tan Ek Khoon, Associate Consultant,
Department of Hepato-pancreato-biliary and Transplant Surgery,
Singapore General Hospital (SGH), a member of the
Non-alcoholic steatohepatitis (NASH) symptoms
During the early stages of NASH, most people who suffer from it are unaware they have liver disease. However, as the condition progresses and liver damage worsens, the following symptoms may appear:
- Fatigue and weakness
- Unexplained weight loss
- Pain in the upper right abdomen
Diagnosing non-alcoholic steatohepatitis
To check for fat build-up in your liver, your doctor may suggest you undergo:
- Blood tests to determine if there is any liver damage.
- Imaging tests such as ultrasound, CT (computerised tomography) scan and MRI (magnetic resonance imaging) to diagnose fatty liver disease.
- Liver biopsy, or taking of a tissue sample from the liver to check for inflammation and scarring. A liver biopsy is done by inserting a long needle through the skin and into the liver to remove liver cells.
Prevention tips for non-alcoholic steatohepatitis
Although there is no treatment for NASH, you can lower your risk of developing a fatty liver or reduce its potential complications by managing the associated risk factors:
- Reduce your total cholesterol level.
- Maintain a healthy weight. If you need to lose weight, be sure to do it gradually – not more than 1.6 kg a week.
- Keep your diabetes under control.
- Exercise regularly. Aim to exercise, e.g. walking or some other form of aerobic exercise, 150 minutes per week, or at least 30 minutes per day, most days of the week.
“Preliminary study results have also shown that patients with NASH should avoid food and soft drinks containing high-fructose corn syrup as it is associated with increasing hepatic fat and inflammation” says Dr Tan.
A recent Duke-NUS study showed that in mice which are fed a high-fat diet, caffeine markedly reduces fatty liver. Caffeine plays a role in reducing the fat content in the liver, and could potentially have important implications in humans since it is widely consumed and easily available.