Have you ever heard of NASH?

It will become the leading cause of liver transplants in the USA by 2020.

NASH
NASH is a form of NAFLD in which you have hepatitis—inflammation of the liver—and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer .
Experts are not sure why some people with NAFLD have NASH while others have simple fatty liver.
How common are NAFLD and NASH?
NAFLD is one of the most common causes of liver disease in the United States. Most people with NAFLD have simple fatty liver. Only a small number of people with NAFLD have NASH. Experts estimate that about 20 percent of people with NAFLD have NASH.1
Between 30 and 40 percent of adults in the United States have NAFLD. About 3 to 12 percent of adults in the United States have NASH.1
Who is more likely to develop NAFLD?
NAFLD is more common in people who have certain conditions, including obesity and conditions that may be related to obesity, such as type 2 diabetes. Researchers have found NAFLD in 40 to 80 percent of people who have type 2 diabetes and in 30 to 90 percent of people who are obese.2 In research that tested for NAFLD in people who were severely obese and undergoing bariatric surgery, more than 90 percent of the people studied had NAFLD.3
NAFLD is more common in people who are obese.
NAFLD can affect people of any age, including children. Research suggests that close to 10 percent of U.S. children ages 2 to 19 have NAFLD.4 However, people are more likely to develop NAFLD as they age.
While NAFLD occurs in people of all races and ethnicities, it is most common in Hispanics, followed by non-Hispanic whites.2 NAFLD is less common in African Americans.2 Asian Americans are more likely than people of other racial or ethnic groups to develop NAFLD when their weight is within the normal range.5
What are the complications of NAFLD and NASH?
The majority of people with NAFLD have simple fatty liver, and people with simple fatty liver typically don’t develop complications.1
NASH can lead to complications, such as cirrhosis and liver cancer. People with NASH have an increased chance of dying from liver-related causes.3
If NASH leads to cirrhosis, and cirrhosis leads to liver failure, you may need a liver transplant to survive.
Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease. Cardiovascular disease is the most common cause of death in people who have either form of NAFLD.6
Symptoms & Causes
What are the symptoms of NAFLD and NASH?
Usually, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are silent diseases with few or no symptoms. You may not have symptoms even if you develop cirrhosis due to NASH.
If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.
What causes NAFLD and NASH?
Experts are still studying the causes of NAFLD and NASH. Research suggests that certain health conditions make you more likely to develop NAFLD or NASH.
Causes of NAFLD
You are more likely to develop NAFLD—either simple fatty liver or NASH—if you
• are overweight or obese
• have insulin resistance
• have abnormal levels of fats in your blood, which may include
o high levels of triglycerides
o abnormal levels of cholesterol—high total cholesterol, high LDL cholesterol, or low HDL cholesterol
• have metabolic syndrome or one or more traits of metabolic syndrome. Metabolic syndrome is a group of traits and medical conditions linked to overweight and obesity. People with metabolic syndrome are more likely to develop type 2 diabetes and heart disease. Experts think NAFLD may be closely linked to metabolic syndrome. Doctors define metabolic syndrome as the presence of any three of the following:
o large waist size
o high levels of triglycerides in your blood
o low levels of HDL cholesterol in your blood
o high blood pressure
o higher than normal blood glucose levels
• have type 2 diabetes
Research also suggests that certain genes may make you more likely to develop NAFLD. Experts are still studying the genes that may play a role in NAFLD.
In NAFLD, people have a buildup of fat in the liver that is not caused by alcohol use. If you have a history of heavy alcohol use and fat in your liver, your doctor may determine that you have alcoholic liver disease instead of NAFLD.

Causes of NASH
Experts are not sure why some people with NAFLD have NASH and others have simple fatty liver. Research suggests that certain genes may play a role.
People with NAFLD are more likely to have NASH if they have one or more of the following conditions:
• obesity, especially with a large waist size
• high blood pressure
• high levels of triglycerides or abnormal levels of cholesterol in their blood
• type 2 diabetes
• metabolic syndrome
Less common causes of NAFLD and NASH
Less common causes of NAFLD and NASH include
• disorders that cause your body to use or store fat improperly
• rapid weight loss
• certain infections, such as hepatitis C
• certain medicines, such as
o amiodarone (Cordarone, Pacerone)
o diltiazem
o glucocorticoids
o highly active antiretroviral therapy
o methotrexate (Rheumatrex, Trexall)
o synthetic estrogens
o tamoxifen (Nolvadex, Soltamox)
o valproic acid
• exposure to some toxins
A study funded by the National Institute of Diabetes and Digestive and Kidney Diseases found that people who had surgery to remove their gallbladder were more likely to develop NAFLD. More research is needed on the link between gallbladder removal and NAFLD.
Treatment
How do doctors treat NAFLD and NASH?
Doctors recommend weight loss to treat nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Weight loss can reduce fat in the liver; inflammation; and fibrosis, or scarring.
If you are overweight or obese, losing weight by making healthy food choices, limiting portion sizes, and being physically active can improve NAFLD and NASH. Losing at least 3 to 5 percent of your body weight can reduce fat in the liver. You may need to lose up to 10 percent of your body weight to reduce liver inflammation.7
Doctors recommend gradually losing 7 percent of your body weight or more over the course of 1 year.8 Rapid weight loss through fasting—eating and drinking nothing except water—can make NAFLD worse.
If you are overweight or obese, losing weight can improve NAFLD and NASH.
How can I prevent NAFLD and NASH?
You may be able to prevent NAFLD and NASH by eating a healthy diet, limiting your portion sizes, and maintaining a healthy weight.
Eating, Diet, & Nutrition
How can my diet help prevent or treat NAFLD and NASH?
If you don’t have nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), you may be able to prevent these conditions by eating a healthy diet, limiting your portion sizes, and maintaining a healthy weight.
If you have NAFLD or NASH, your doctor may recommend gradually losing weight if you are overweight or obese.
Your doctor may suggest limiting your intake of fats to help prevent or treat NAFLD or NASH. Fats are high in calories and increase your chance of becoming obese. Four types of fats are
• saturated fats, found in meat, poultry skin, butter, lard, shortening, and all milk and dairy products except fat-free versions.
• trans fats, found in foods that list hydrogenated or partially hydrogenated oil on the label, such as crackers and snack foods, commercially baked goods such as cookies and cakes, and fried foods such as doughnuts and french fries.
• monounsaturated fats, found in olive, peanut, and canola oils.
• polyunsaturated fats, found in greatest amounts in corn, soybean, and safflower oils, and many types of nuts. Omega-3 fatty acids are a type of polyunsaturated fat. Sources include oily fish such as salmon, walnuts, and flaxseed oil.
Replacing saturated fats and trans fats in your diet with monounsaturated fats and polyunsaturated fats, especially omega-3 fatty acids, may reduce your chance of heart diseaseif you have NAFLD.
Your doctor may suggest other dietary changes to help treat NAFLD and NASH:
• Eat more low-glycemic index foods—such as most fruits, vegetables, and whole grains. These foods affect your blood glucose less than high-glycemic index foods, such as white bread, white rice, and potatoes.
• Avoid foods and drinks that contain large amounts of simple sugars, especially fructose. Fructose is found in sweetened soft drinks, sports drinks, sweetened tea, and juices.
• Avoid heavy alcohol use, which can damage your liver. For men, experts define heavy alcohol use as more than 4 drinks per day or more than 14 drinks per week. For women, heavy alcohol use is more than 3 drinks per day or more than 7 drinks per week.10