Non-Alcoholic Steatohepatitis (NASH)
What is Non-Alcoholic Steatohepatitis (NASH)?
Non-alcoholic steatohepatitis, or NASH, is a serious liver condition marked by inflammation and cell damage. It occurs when fat builds up in the liver of people who drink little to no alcohol. Unlike simple fatty liver, NASH causes the liver tissue to become inflamed and scarred over time.
NASH is the progressive form of non-alcoholic fatty liver disease, or NAFLD. While many people with fatty liver stay healthy, about 20 percent progress to NASH. This progression matters because NASH can lead to permanent liver scarring, called cirrhosis, and even liver failure if left unmanaged.
The condition often develops silently over many years. Most people feel fine in the early stages. This makes blood testing essential for catching liver inflammation before serious damage occurs. Early detection through liver enzyme monitoring helps you make lifestyle changes that can reverse or slow the disease.
Symptoms
- Fatigue and weakness that persists despite rest
- Discomfort or dull ache in the upper right abdomen
- Unexplained weight loss without trying
- Loss of appetite or feeling full quickly
- Yellowing of the skin or eyes, called jaundice
- Swelling in the abdomen or legs from fluid buildup
- Enlarged liver detected during physical examination
- Spider-like blood vessels visible on the skin
Most people with NASH have no symptoms in the early stages. The liver can sustain significant damage before warning signs appear. This is why regular blood testing for liver enzymes is so important, especially if you have risk factors like diabetes or metabolic syndrome.
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Causes and risk factors
NASH develops when fat accumulates in liver cells and triggers inflammation. Insulin resistance plays a central role in this process. When cells stop responding properly to insulin, the liver produces more fat and struggles to break it down. This creates a cycle of fat buildup, inflammation, and cellular damage. Type 2 diabetes, prediabetes, and metabolic syndrome significantly increase NASH risk.
Other risk factors include obesity, especially excess belly fat, high cholesterol, high triglycerides, and rapid weight loss. Certain medications, hormonal disorders like polycystic ovary syndrome, and sleep apnea also contribute. Age matters too, with risk increasing after 50. However, NASH can affect people of any weight, and up to 20 percent of patients have a normal body mass index. Genetics influence who develops NASH, with some people more susceptible to liver inflammation from metabolic stress.
How it's diagnosed
NASH diagnosis starts with blood tests that measure liver enzymes. Alanine aminotransferase, or ALT, and aspartate aminotransferase, or AST, reveal liver cell inflammation and damage. Gamma-glutamyl transferase, or GGT, reflects oxidative stress and inflammation in liver tissue. Elevated levels suggest liver injury and indicate the need for further evaluation. Rite Aid tests these liver function markers as part of our flagship panel at Quest Diagnostics locations nationwide.
Blood tests alone cannot definitively diagnose NASH or distinguish it from simple fatty liver. Imaging studies like ultrasound, CT scans, or MRI can show fat in the liver but cannot measure inflammation. A liver biopsy remains the gold standard for confirming NASH and assessing the degree of scarring. Your doctor may also use non-invasive scoring systems that combine blood test results, imaging, and clinical factors to estimate disease severity and fibrosis risk.
Treatment options
- Lose 7 to 10 percent of body weight through diet and exercise to reduce liver fat and inflammation
- Follow a Mediterranean-style diet rich in vegetables, whole grains, fish, and healthy fats
- Limit added sugars, especially fructose from sweetened beverages and processed foods
- Exercise at least 150 minutes per week with moderate-intensity aerobic activity
- Control blood sugar through diet, medication, and regular monitoring if you have diabetes
- Manage cholesterol and triglycerides with lifestyle changes or medications like statins
- Avoid alcohol completely, as even small amounts can worsen liver damage
- Treat underlying conditions like sleep apnea that contribute to metabolic dysfunction
- Work with your doctor on medications for NASH, including emerging therapies in clinical trials
- Monitor liver enzymes regularly to track disease progression and treatment response
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- Simple blood draw at your nearest lab
- Results in days, not weeks
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Frequently asked questions
NAFLD is non-alcoholic fatty liver disease, an umbrella term for fat buildup in the liver. NASH is the more serious, progressive form of NAFLD that includes inflammation and liver cell damage. About 80 percent of people with NAFLD have simple fatty liver without inflammation, while 20 percent progress to NASH. Only NASH carries significant risk of cirrhosis and liver failure.
Yes, NASH can improve or even reverse with significant lifestyle changes, especially weight loss. Losing 7 to 10 percent of body weight reduces liver fat and inflammation in most patients. Some studies show that losing 10 percent or more of body weight can reverse liver scarring in early-stage NASH. However, success requires sustained changes to diet, exercise, and metabolic health.
Most doctors recommend testing liver enzymes every 3 to 6 months when monitoring NASH. More frequent testing may be needed if you are making lifestyle changes or starting new medications. Regular monitoring helps track whether inflammation is improving, worsening, or staying stable. Rite Aid offers liver enzyme testing twice per year as part of our subscription service.
Yes, up to 50 percent of people with NASH have normal ALT levels on blood tests. Normal liver enzymes do not rule out NASH or even advanced liver scarring. This is why doctors consider multiple factors including imaging studies, metabolic health markers, and sometimes liver biopsy. If you have risk factors like diabetes or obesity, further evaluation may be needed even with normal blood tests.
Avoid foods high in added sugars, especially fructose from sweetened drinks and processed foods. Limit refined carbohydrates like white bread, white rice, and pastries that spike blood sugar. Reduce saturated fats from red meat and full-fat dairy products. Cut out alcohol completely, as it worsens liver inflammation even in small amounts.
No, NASH does not always progress to cirrhosis, but the risk is significant without intervention. Studies suggest that 20 to 30 percent of people with NASH develop cirrhosis over 10 to 20 years. Progression depends on factors like the degree of inflammation, presence of scarring, diabetes control, and lifestyle changes. Early detection and treatment can prevent or slow progression to cirrhosis.
The AST to ALT ratio compares two liver enzymes to help assess disease severity. In early NASH, ALT is usually higher than AST, giving a ratio less than 1. As NASH progresses and fibrosis develops, AST rises more than ALT, pushing the ratio above 1. A ratio greater than 1 suggests more advanced liver scarring and higher risk of cirrhosis.
As of now, no medications are specifically approved by the FDA for NASH treatment. However, several drugs are in late-stage clinical trials and may gain approval soon. Doctors sometimes prescribe vitamin E for non-diabetic patients or pioglitazone for diabetic patients with NASH, based on research showing benefits. Managing underlying conditions like diabetes and high cholesterol with appropriate medications also helps.
Yes, lean people can develop NASH even without obesity. About 10 to 20 percent of NASH patients have a normal body mass index. Genetics, insulin resistance, and where fat is stored in the body matter more than weight alone. Some people deposit excess fat in the liver rather than under the skin, creating metabolic problems despite normal weight.
Diabetes significantly increases NASH risk and accelerates disease progression. High blood sugar and insulin resistance drive fat accumulation and inflammation in the liver. People with diabetes are more likely to develop advanced fibrosis and cirrhosis from NASH. Good blood sugar control through medication, diet, and exercise can slow NASH progression and reduce liver inflammation.