Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) where fat builds up in the liver, causing swelling and damage. NASH is a leading cause of cirrhosis in the US. Risk factors include obesity, diabetes, high cholesterol, and metabolic syndrome. Symptoms may include fatigue, abdominal pain, itching, bruising, and jaundice. Treatment focuses on lifestyle changes like weight loss through diet and exercise to reduce fat buildup and liver damage progression. A liver biopsy may be needed to assess liver damage severity and potential scarring.

1. I've been diagnosed with NAFLD / NASH
Nonalcoholic steatohepatitis (NASH) is the more
severe form of nonalcoholic fatty liver disease
(NAFLD), a condition in which fat builds up in
the liver. NASH causes the liver to swell and
become damaged. NASH is one of the leading
causes of cirrhosis (severe scarring of the liver,
which can lead to liver failure) in the US.
What is NAFLD/NASH?
Stages of liver damage:
Stage 0 – healthy liver
Stage 1 – beginning of liver damage
Stage 2 – moderate liver damage
Stage 3 – significant liver damage
Stage 4 – severe liver damage (cirrhosis)
Who is at risk? If you:
Are overweight/obese
Have type 2 diabetes
Have high LDL cholesterol/high triglycerides
Have metabolic syndrome
Are of Hispanic descent
Symptoms of NAFLD/NASH:
Fatigue
Pain in the upper right side of your abdomen
Itching
Abdominal swelling (ascites)
Bruising/bleeding easily
Yellowing of skin and eyes (jaundice)
Spider-like blood vessels just under skin
surface
Behavior changes, slurred speech, confusion
(hepatic encephalopathy)
NASH often has no symptoms, and people can
have NASH for years before they notice
symptoms:
If you have severe liver scarring, you may also
have symptoms of cirrhosis:
Your doctor will ask you:
The medicines you take
Your alcohol use
Your diet
Your level of physical activity
Other conditions such as type 2
diabetes, obesity, hypertension, or
high triglycerides/abnormal
cholesterol levels
During the exam, the doctor will:
Perform a physical exam
Examine your body for an enlarged
liver and yellowing of the skin and
whites of your eyes
Check your height and weight to
calculate your Body Mass Index (BMI)
Check your medical history
Perform blood tests, imaging tests,
and liver biopsy in some cases
Questions to ask your doctor:
How severe is the liver damage?
What treatment do you
recommend?
Will the treatment slow down the
progression of NASH/NAFLD?
Should I change my diet?
If cirrhosis develops, is a liver
transplant my only option?
Treatment Options
There are no FDA-approved medicines for
NAFLD/NASH, but treatments are expected
to be available in the next few years. Limit intake of fats because they are high in calories and may increase
chance of developing obesity
Replace saturated fats and trans fats with unsaturated fats like vegetable oil
Eat more low-glycemic foods like fruits, vegetables, whole grains
Eat less high-glycemic foods like white bread, white rice, and potatoes
Avoid foods and drinks with high amounts of simple sugars like fructose
which is found in juices, sodas, sports drinks, and sweetened tea.
Diet
Adjusting your diet can help with NAFLD/NASH. Your doctor may suggest:
Liver Biopsy:
Your doctor will take blood
samples to make sure your blood
clots properly
No eating/drinking for 8 hours
before
You will have a bandage over the
cut and you will need to lie on your
right side for a few hours
Limited physical activity
May be sore for a few hours/days
How do I prepare for a liver biopsy?
After biopsy:
Preventing further liver damage
Avoid alcohol
Take medicines/supplements as
instructed by your doctor
Get vaccinated for hepatitis A and B
Websites/Support Groups
https://nash-now.org/nash-support-group/
https://www.facebook.com/groups/282616099043047/
NASH kNOWledge
American Liver Foundation
Losing 3-5% of your body weight to reduce
fat in the liver
Losing 7-10% of your body weight to reduce
liver inflammation and fibrosis
Physical activity
Gradual weight loss over 1 year - rapid
weight loss and malnutrition can worsen liver
disease
Weight Loss
Losing weight can reduce fat, inflammation, and
fibrosis/scarring in the liver, so your doctor may
recommend:
Meat & Poultry
Shortening
Dairy Products
Saturated
Olive oil
Canola oil
Peanut Oils
Corn oil
Safflower oil
Soybean oil
Nuts
Salmon
Flaxseed oil
Walnuts
Polyunsaturated
Sources: The Liver Foundation, 2023; NIDDK, 2023.

2. My Treatment Plan
Diagnosis Date: ______________________
Alanine aminotransferase (ALT)
Aspartate animotransferase (AST)
AST-to-Platelet Ratio (APRI) score
Fibrosis-4 (Fib-4) score
Hepatitis C
Wilson disease
Hemoglobin A1C
Liver Function:
Fibrosis Assessment:
Lipid Profile
Test for co-existing causes of fatty liver:
Tired/Fatigue
Abdominal Pain/Swelling
Itching
Bruising/Bleeding Easily
Yellow Skin/Eyes
Spider-Like Blood Vessels Under the Skin
Slurred Speed
Confusion
Behavior Changes
Symptoms
Referrals
Nutritionist: _________________________________
Hepatologist: _______________________________
Bariatric Specialist: ___________________________
Obesity Specialist: ___________________________
Other: ____________________________________
Avoid alcohol
Increase physical activity
Make dietary changes
Schedule referral appointments
I need to:
Notes from visit:
Next Appointment: ____________________
____________________
____________________
Blood Tests
Imaging Tests
Ultrasound
CT scan
MRI
Transient elastography
MRE
Liver Biopsy
Traditional
Laparoscopic
Transvenous
Lifestyle Changes to Make
Increase weekly exercise: 3x/week for 50 minutes or
5x/week for 30 mins
Replace dairy with olive oil or other unsaturated fats
Replace meals based around meat with fruits,
vegetables, and whole grains
Create weight loss goals with a nutritionist for 1 year
to prevent rapid weight loss/malnutrition
Other: ________________________________
Other: ________________________________
Other: ________________________________