NON-ALCOHOLIC FATTY LIVER DISEASE (NASH)

By Dr. Vipul Agarwal

In the realm of liver health, a silent epidemic is on the rise – Non-Alcoholic Fatty Liver Disease, or NAFLD. Nestled beneath your ribcage, the liver, a vital organ often overlooked, is under siege as fat slowly infiltrates its cells. While this condition may not be as widely recognized as some other health issues, it’s a growing concern that demands our attention. NON-ALCOHOLIC FATTY LIVER DISEASE (NASH)

NAFLD manifests in two distinct forms: Non-Alcoholic Fatty Liver (NAFL), where the liver accumulates fat without inflammation, and its more menacing sibling, Non-Alcoholic Steatohepatitis (NASH), where the liver not only hoards fat but also becomes inflamed. In this article, we delve into the intricacies of NASH, a condition that holds the potential for significant health complications.

What is non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease (sometimes called “NAFLD”) is a condition in which fat builds up in the liver. The liver is a big organ in the upper right side of the belly.

There are 2 types of NAFLD:

• Non-alcoholic fatty liver (also called “NAFL”) – In NAFL, the liver has fat build-up, but is not inflamed.
• Non-alcoholic steatohepatitis (also called “NASH”) – In NASH, the liver has fat build-up and is inflamed.

This article is mostly about NASH, because that is the condition that can lead to the most problems.

People who drink too much alcohol can get a condition similar to NASH. But NASH is not related to drinking too much alcohol.

What causes NASH?

Risk factors for NASH are

• Obesity
• Diabetes
• high cholesterol
• certain medicines

What are the symptoms of NASH?

Most people with NASH have no symptoms.

Your doctor might suspect that you have NASH from the results of your routine blood tests.

Will I need more tests?

Yes. If your doctor suspects that you have NASH, you will likely have:

• More blood tests
• An imaging test of the liver, such as an ultrasound, CT, or MRI scan – Imaging tests create pictures of the inside of the body.

Some people need a liver biopsy. During this test, a doctor removes a small sample of tissue from the liver. Then, another doctor looks at the sample under a microscope to see if NASH is present. A liver biopsy is the only test that can tell for sure if you have NASH. Your doctor might do this test if they are not sure if you have NASH or to see how much inflammation there is in the liver. If your blood tests and imaging tests are normal, you will not need a liver biopsy.

How is NASH treated?

NASH is not typically treated directly. But the condition can get better when other medical conditions that often happen with NASH get treated. For example, losing weight, and controlling high blood sugar and cholesterol can help improve NASH.

With that in mind, your doctor can:

• Help you lose weight, if you are overweight – If your doctor recommends losing weight, they can help you make a plan to do this safely. It’s important not to lose weight too quickly. Do not lose more than 3.5 pounds (1.6 kilograms) a week.
• Treat your high blood sugar, if you have high blood sugar
• Treat your high cholesterol, if you have high cholesterol

Making these changes has benefits besides helping with NASH. These changes can also reduce your chances of having a heart attack or stroke. That’s important because people with NASH are often also at risk for heart disease and stroke.

If you take a medicine that could be causing NASH, your doctor will stop or change that medicine.

If you have a severe form of NASH but do not also have diabetes or heart disease, your doctor or nurse might suggest that you take Vitamin E. A few studies suggest that vitamin E can reduce some of the liver damage that occurs as part of NASH. But there are also studies that suggest that high doses of vitamin E increase the risk of death. So do not take vitamin E unless your doctor recommends it.

Does NASH get worse over time?

NASH might get worse over time. Sometimes, it leads to serious scarring of the liver, called “cirrhosis.” Cirrhosis can cause different symptoms, such as swelling in the legs, trouble breathing, or feeling tired. If you get cirrhosis, your doctor will talk with you about different possible treatments.

Do I need to follow up with my doctor?

Yes. People who have NASH need to see their doctor for regular check-ups. Your doctor will do follow-up tests regularly. These usually include blood tests.

(Dr. Vipul Agarwal is M.B.B.S  MD (Internal Medicine), FAGE, CPCDM(RSSDI)

Consultant physician & Diabetologist in Unique Healthcare Maitri Clinic Jaipur, Rajasthan, India. He can be reached at [email protected] linkedIn/ Instagram/ facebook / Google profile