Fatty Liver Disease, also known as Nonalcoholic steatohepatitis (NASH), mirrors alcoholic liver disease, except that patients who have this disease drink very little or no alcohol at all. Patients with fatty liver disease often experience no symptoms and feel perfectly fine, yet it affects two to five percent of Americans. NASH includes inflammation and liver damage that can later lead to cirrhosis, a condition in which the liver becomes irreversibly damaged and unable to function properly.
The dangerous part of Fatty Liver Disease is that patients experience few or no symptoms indicating they may have this condition. Only when the disease has progressively advanced to the point of cirrhosis do they begin to feel the signs.
Symptoms of fatty liver disease include:
- Unexplainable weight loss
- Feeling of weakness
NASH can take a long time to develop, possibly decades. The body can sometimes stop and even reverse it without medical intervention, but it can also become unknowingly worse. Not everyone who has fatty liver disease develops cirrhosis, but once cirrhosis sets in, there are few treatments to stop it from progressing.
A person with cirrhosis may experience the following symptoms:
- Muscle wasting
- Intestinal bleeding
- Liver failure
- Retention of fluids
A doctor might suspect NASH if a person’s routine blood test contains high liver elevations, which include the presence of alanine aminotransferase (ALT) or aspartate aminotransferase (AST). If upon further evaluations and tests, no reasons for a liver disease appear (such as taking certain medications or drinking excessive amounts of alcohol), and an ultrasound shows that the liver contains fat, NASH might be the cause. Your physician will likely order additional blood tests to look for other causes of liver disease.
A liver biopsy can occasionally be performed and provide evidence of NASH. If the sample tissue shows evidence of fat, inflammation and liver cell damage or scarring, NASH is then diagnosed. If the liver tissue shows fat, but does not contain inflammation or evidence of scarring, NASH is ruled out.
NASH can also be determined using FibroScan®, also called transient elastography. This is a non-invasive and painless test which is used to assess liver stiffness. This test is conducted in your doctor’s office.
Doctors are still exploring the underlying causes for NASH. It is commonly found in patients who are also experiencing elevated cholesterol, diabetes or prediabetes. Not every diabetic or obese person will develop NASH, and the disease can still occur in patients without any of these additional risk factors, including children. People who are middle-aged and overweight or obese are noted to be especially susceptible.
Fatty liver disease is hard to detect early. Currently, there are no therapies specific to NASH, but if NASH is diagnosed and has not progressed to cirrhosis, patients can help manage their condition by:
- Keeping a healthy weight
- Eating a balanced, healthy diet
- Staying physically active
- Limiting or avoiding alcohol and medications
Since people with NASH commonly have other conditions like diabetes, weight control should be highly considered because it can help manage both conditions and it may even reverse NASH to some degree. Do not avoid taking medication or other treatments to help manage other conditions.