NASH – The story of the invisible threat to your liver and its link to obesity

Micrograph of non-alcoholic fatty liver disease, demonstrating marked steatosis (fatty liver appears white). Credit: Wikimedia commons
Micrograph of non-alcoholic fatty liver disease, demonstrating marked steatosis (fatty liver appears white). Credit: Wikimedia commons

Suffering from something you haven’t even heard of, sounds like something from the medieval times right? But such things, still happen, in the 21st century! The only difference is that this time, it is not due to lack of research but a lack of awareness.

Sophia, who worked at a retail store, wondered why her GP referred her to a liver specialist. She just had common problems like fatigue and overweight that most women her age suffered from. But Sophia had a pit in her stomach when they asked her to go for a liver biopsy as they had found abnormally high levels of certain enzymes in her blood. And she was diagnosed with the fourth stage of NASH and a notice of merely a month’s time to undergo a liver transplantation. In addition, she had to deal with the stigma that she would have to face while sharing about her condition cirrhosis, that is often associated with alcohol abuse.

Liver diseases are often related to excessive alcohol consumption, however, there are a range of conditions which have a similar pathogenesis caused by obesity, diabetes or high cholesterol. NASH or Nonalcoholic steatohepatitis is one such serious disease, and owing to the not so obvious symptoms, has been poorly understood and erratically diagnosed.

Obesity = Liver pays the hefty price 

Non-alcoholic fatty liver disease or NAFLD is an umbrella term used for a range of conditions ranging from fat deposition in the liver to inflammation and scar tissue formation. NASH  is one of the diseases under NAFLD and is caused due to an inflamed liver.

Diet and physical activity are the lifestyle triggers for NASH in addition to genetic predisposition. Certain medical conditions are known to be in the high-risk radar of NASH, namely, obesity, diabetes, high level of fat in the blood (hyperlipidemia) and polycystic ovary condition (PCOD, in women).

Any early red flags?

NASH is asymptomatic, and hence all the more reason why awareness about it is crucial. NASH goes undetected for years together, sometimes a lifetime, and death occurs due to the triggered conditions such as liver cancer or cardiovascular disease. In the later stages, this disease manifests itself through excess fatigue, a loss of appetite and weight. In some cases of chronic liver damage, the symptoms are jaundice-like yellowing of skin and eyes. Some of the more severe effects include fluid accumulation in the legs and abdomen, spider-like veins and mental loss and poor concentration.

For an accurate diagnosis, the most common liver afflictions such as hepatitis B and C, and cases of excessive alcohol consumption must be ruled out. The imaging tests such as ultrasonography, CT scan, and MRI scan, are not able to identify between steatosis and the inflammation caused by NASH. The only conclusive test available so far is a liver biopsy, which people generally shy away from, primarily because of the cost and the dread that even if they find out they do have NASH, there is no standard treatment available.

G”NASH”ing the cure

Obesity being the major risk factor, a healthy diet, avoiding alcohol intake, coupled with exercise and a mindful lifestyle is a great way to combat the onset of fatty liver disease. Addressing the underlying conditions such as diabetes or PCOD is highly recommended. Most of the molecules under clinical trials now might be able to provide improvements in only a minority of patients. Thus, the only hope for NASH, a lifestyle disease, is an integrated approach to diet and control risk factors that could suppress the inflammation that induces NASH.