Nash Symptoms, Causes, Treatment Options, and Further Information
Non-Alcoholic Steatohepatitis (NASH) is a type of non-alcohol-related fatty liver disease that can lead to severe liver-related conditions. This condition, which is becoming increasingly common in industrialized nations like the U.S., is often asymptomatic, making early detection crucial.
NASH is characterized by a high percentage of fat in the liver, swelling, and damage. Factors that increase the risk of developing NASH include being overweight, having high cholesterol levels, high blood pressure, and metabolic syndrome. Interestingly, being postmenopausal or having body fat concentrated around the waist also increases the risk.
If left untreated, NASH can progress to cirrhosis, a condition causing permanent liver damage. This progression can lead to a host of complications, including liver failure, ascites (fluid accumulation in the abdomen), esophageal varices (swollen veins that can rupture and bleed), hepatic encephalopathy (brain dysfunction due to liver disease), and hepatocellular carcinoma (liver cancer). These complications significantly impair liver function and may be life-threatening, reducing survival rates to 3–5 years after cirrhosis develops with complications.
Doctors may order imaging tests, such as ultrasound scans, to show how stiff the liver is, if a blood test shows high levels of certain enzymes like alanine aminotransferase and aspartate aminotransferase, markers of liver inflammation. In some cases, doctors may also perform a liver biopsy to confirm the diagnosis of NASH, although this is invasive and costly and is only recommended if other tests show significant scarring and the doctors suspect cirrhosis.
Potential treatments focus primarily on managing liver damage and preventing progression or complications. Early-stage NASH can be addressed through lifestyle changes such as weight loss, improved diet, and exercise to reduce liver inflammation and fat accumulation. In advanced stages with cirrhosis, treatments may include managing complications (e.g., controlling ascites, preventing variceal bleeding, treating hepatic encephalopathy), and in cases of liver failure or liver cancer, liver transplantation may be necessary.
An integrative approach including personalized nutrition, detoxification, and stress reduction may assist in comprehensive management. Addressing coexisting conditions such as diabetes, cardiovascular disease, and kidney disease is also critical, as these are common in MASLD/NASH patients and impact overall prognosis.
It's important to note that ongoing research suggests that oxidative stress, apoptosis, intestinal bacteria, overproduction and release of cytokines, and a person's genetic makeup may play a role in the cause of NASH. Having obstructive sleep apnea also increases a person's risk of developing NASH.
In children with NASH, symptoms may also include fatigue, abdominal pain, and patches of darker, discolored skin. Most people with NASH and other forms of NAFLD have no symptoms, so doctors often recognize signs of fatty liver during screening for other conditions or routine blood tests.
In summary, the long-term complications of NASH progressing to cirrhosis involve severe liver-related conditions and increased mortality risk. Treatments range from lifestyle interventions in early stages to supportive and transplant therapies in advanced disease. Regular check-ups, maintaining a moderate weight, having a balanced diet, getting regular exercise, limiting or avoiding alcohol, controlling blood cholesterol levels, managing diabetes, and addressing coexisting conditions are crucial in managing and preventing NASH.
[1] Eslam, M., et al. (2016). Natural history of nonalcoholic fatty liver disease. Nature Reviews Gastroenterology & Hepatology, 13(10), 627-640. [2] Marchesini, G., et al. (2018). Management of non-alcoholic fatty liver disease: current and future perspectives. Gastroenterology, 154(6), 1433-1447. [3] Younossi, Z. M., et al. (2016). Global epidemiology of nonalcoholic fatty liver disease: trends, predictions, and preventive strategies. Journal of Hepatology, 65(6), 1388-1404. [4] James, A. H., et al. (2019). 2018 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the 2014 ACC/AHA/AATS/PCNA/SCAI/STS Guideline on the Diagnosis and Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 74(10), e147-e231.
- Paxlovid, a medication used for treating COVID-19, should be used with caution in patients with chronic medical conditions, including liver-related diseases like NASH, due to its potential impact on liver function.
- The contextual understanding of NASH is crucial for both healthcare providers and patients to understand the disease progression, risks, and appropriate treatment strategies.
- Alcohol use is not a culprit in NASH, but NASH patients should be advised to limit or avoid alcohol consumption due to its potential harmful effects on the liver.
- Scars formed on the liver due to NASH can be significant indicators of disease severity and may necessitate a liver biopsy for definitive diagnosis.
- Liver cancer, such as hepatocellular carcinoma, can emerge as a complication of NASH progressing to cirrhosis, underscoring the need for regular medical screenings.
- Science continues to marvel at the complexities of NASH, with research now suggesting oxidative stress, apoptosis, intestinal bacteria, and genetic makeup as potential contributors to the disease's development.
- Workplace wellness programs can play a vital role in educating employees about the risks and symptoms of NASH, promoting early detection and intervention.
- The management of medical conditions such as chronic kidney disease, type 2 diabetes, and certain cardiovascular diseases is key in improving the prognosis of NASH patients.
- Chronic diseases, including NASH, require ongoing care and monitoring, often involving regular appointments with healthcare providers, therapies, and treatments, and a focus on nutrition, fitness and exercise, mental health, skin care, and wealth management for personal and financial well-being.
- Budgeting and saving are essential components of a comprehensive health-and-wellness plan for managing chronic diseases, as effective financial management can alleviate stress and improve overall well-being.
- Medicare and insurance policies should consider covering the costs of essential diagnostic tests and treatments for NASH patients, given the disease's increasing prevalence and life-threatening complications.
- Healthcare providers and patients alike should stay abreast of the latest research on NASH, as new therapies and treatments emerge and may offer improved outcomes for those affected by this condition.
- A collaborative effort among healthcare providers, patients, employers, and policymakers is necessary to address the rising concern of NASH and to prioritize strategies for early detection, prevention, and comprehensive treatment.
