Nonalcoholic Steatohepatitis (NASH), or fatty liver disease, is a problem that is occurring with increasing frequency in this country as obesity reaches epidemic proportions. NASH is a distinct clinical entity in which patients have a liver biopsy
that upon pathologic analysis has findings identical to those observed in alcoholic fatty liver disease (alcoholic steatohepatitis), but who do not overuse alcohol.
The major risk factors for NASH are obesity, diabetes mellitus type 2, high cholesterol, and the metabolic syndrome. The majority of cases occur between the age of 40 and 60. The prevalence of the disease varies substantially with ethnicity. On study showed that the disease affects 45% of Hispanic Americans, 33% of Caucasian Americans, and 24% of African Americans. The vast majority of cases are asymptomatic, however the most common symptoms are an enlarged liver or vague right upper abdominal pain. The prognosis of NASH is variable. In one study, patients with NASH had a slightly lower life expectancy than the general population, with a mortality ratio of about 1.5:1. In most patients the disease is stable over time and does not progress to more severe liver dysfunction. However in a subpopulation of patients, the disease progresses to increasingly severe liver disease and eventually cirrhosis or total liver failure. In the liver transplant literature it has been documented that NASH is an increasingly frequent indication for liver transplant in the United States. Cancer is not a well documented feature of the natural history of NASH, however hepatocellular carcinoma can frequently arise in the setting of cirrhosis. The risk factors for progression of the disease are not well understood, however some studies have shown that diabetes, severe obesity, older age, and more severe abnormalities in liver function tests at the time of diagnosis are independent risk factors for progressive disease. The best preventative measures for severe or progressive disease are weight loss
and increased exercise. NASH is a potentially serious disease and one that should be discussed in detail with and fully evaluated by a specialist such as a gastroenterologist
, so I advise you to seek consultation as soon as possible to discuss the severity of your disease and what treatment or lifestyle changes would be best for you.