NASH: The Emerging Most Common Form of Chronic Liver Disease

Abstract

Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease that can progress to cirrhosis and hepatocellular carcinoma. This review provides brief answers to common questions clinicians may have about NASH. The diagnosis of NASH currently requires a liver biopsy, although non-invasive tests are being evaluated and may supplant liver biopsy in the near future. Treatment is focused on lifestyle modifications, with new medications currently in clinical trials.

Figure 1

Figure. NASH develops in the setting of excess fat being transported to the liver or being produced in the liver, in conjunction with limitations on the capacity of the liver to oxidize fat or return it to the circulation as very low density lipoprotein (VLDL). Dietary factors such as fructose and glucose consumption contribute to this process. The role of genetics, epigenetic changes, and other modifying factors, such as the gut microbiome, are currently being explored in research studies. Multiple treatment options that target differents steps of these pathways are undergoing evaluation in clinical trials. Reducing caloric intake, especially from carbohydrates, and increasing disposal through regular aerobic exercise remain the primary treatment recommendations.