Nonalcoholic Steatohepatitis (NASH)

Now known as metabolic dysfunction-associated steatohepatitis (MASH).

All livers contain some fat, but the liver’s normal fat level is 5 to 10 percent. If an individual’s liver has more fat than that, it’s evidence of fatty liver disease. Nonalcoholic steatohepatitis (NASH) is a more severe form of fatty liver disease, which in many people begins as nonalcoholic fatty liver disease (NAFLD), also referred to as metabolic dysfunction-associated steatotic liver disease (MASLD).

NASH causes the liver to become inflamed (swollen) and damaged. Over time, NASH can decrease liver function. As the liver tries to repair and replace damaged cells, the healing process can leave behind scar tissue. If the liver gets scarred enough, it becomes unable to work properly. This is known as cirrhosis of the liver. NASH can also lead to liver cancer or liver failure.

About 25 percent of people with NAFLD go on to develop NASH.


Often, NASH has no noticeable symptoms at first. As NASH progresses, symptoms may include:

  • Fatigue and tiredness
  • Discomfort in the upper right side of the abdomen
  • Yellowing of the skin or eyes (jaundice)
  • Unexplained weight loss
  • Weakness
  • Spider veins
  • Itchiness

Risk Factors

Although the causes of NASH are unclear, certain conditions raise a person’s risk of developing the condition. About 25 percent of people with NAFLD will go on to develop NASH. Risk factors for NASH include:

  • An existing diagnosis of NAFLD
  • Obesity, especially if fat is concentrated in the belly (abdomen)
  • Metabolic syndrome
  • High cholesterol
  • High triglyceride levels in the blood
  • Type 2 diabetes or prediabetes
  • High blood pressure
  • Polycystic ovary syndrome
  • Sleep apnea
  • Underactive thyroid
  • Underactive pituitary gland

When to See a Doctor

If you have symptoms that concern you or are consistent with NASH, it’s smart to see a doctor for a thorough exam and consultation. Early treatment can control your symptoms and prevent your condition from getting worse.

Treatment Options

The only effective treatment for NASH is to avoid alcohol, lose weight, and control your risk factors. For people with NASH, your doctor may recommend lifestyle changes that include:

  • Losing extra weight
  • Eating a healthy diet
  • Getting regular exercise
  • Controlling diabetes (with medication, if needed)
  • Reducing cholesterol and triglyceride levels in the blood (with medication, if needed)
  • Avoiding alcohol
  • Talking with your doctor about other medications you’re taking that may affect your liver

Through our clinical research arm, Chevy Chase Clinical Research and our Norfolk, Virginia office, we offer our patients access to the latest therapies for fatty liver disease – before they’re available anywhere else.

Diagnostic Testing

The foremost diagnostic test for any condition is a thorough exam and consultation with a physician, including a review of your individual and family history. In addition, your physician may recommend any of the following tests or procedures, which may provide further diagnostic value:


Many of NASH’s causes are treatable or preventable, so discuss any risk factors you have with your doctor. If you develop NASH, it may be possible to prevent your condition from getting worse with lifestyle changes. Work with your doctor to develop a healthy fatty liver disease diet for you.

Learn More

Learn more about NASH with resources from the National Institutes of Health.

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