National Digestive Diseases Information Clearinghouse
a common, often “silent” liver disease. It
results or scans of the liver, this problem
resembles alcoholic liver disease, but occurs
is called nonalcoholic fatty liver disease
in people who drink little or no alcohol.
in this case, it will show that some people
liver, along with inflammation and damage.
not aware that they have a liver problem.
Nevertheless, NASH can be severe and
can lead to cirrhosis, in which the liver is
greater number of Americans with obesity.
In the past 10 years, the rate of obesity hasdoubled in adults and tripled in children.
NASH affects 2 to 5 percent of Americans.
high blood cholesterol, which can further
cans have fat in their liver, but no inflam-
mation or liver damage, a condition called
“fatty liver.” Although having fat in the
liver is not normal, by itself it probably
causes little harm or permanent damage.
of Health and
liver or NAFLD is diagnosed. An impor-tant piece of information learned from the
NASH is usually first suspected in a person
biopsy is whether scar tissue has developed
in the liver. Currently, no blood tests or
tests that are included in routine blood test
scans can reliably provide this information.
panels, such as alanine aminotransferase(ALT) or aspartate aminotransferase(AST). When further evaluation shows no
apparent reason for liver disease (such as
NASH is usually a silent disease with few
medications, viral hepatitis, or excessive
use of alcohol) and when x rays or imaging
well in the early stages and only begin to
studies of the liver show fat, NASH is sus-
pected. The only means of proving a diag-
simple fatty liver is a liver biopsy. For a
liver biopsy, a needle is inserted through
worsen, causing scarring or “fibrosis” to
damage to liver cells. If there is fat without
fibrosis worsens, cirrhosis develops; the
A small, slender core of tissue isremoved with a biopsy needle andlooked at under the microscope.
liver becomes seriously scarred, hardened,
and unable to function normally. Not every
once serious scarring or cirrhosis is present,
few treatments can halt the progression.
or every patient with diabetes has NASH.
A person with cirrhosis experiences fluid
have normal blood cholesterol and lipids.
transplantation is the only treatment for
advanced cirrhosis with liver failure, and
factor and can even occur in children.
transplantation is increasingly performed
one of the major causes of cirrhosis inAmerica, behind hepatitis C and alcoholic
While the underlying reason for the liver
injury that causes NASH is not known,several factors are possible candidates:
• release of toxic inflammatory proteins
mon, its underlying cause is still not clear.
• oxidative stress (deterioration of cells)
middle-aged and overweight or obese.
Another experimental approach to treatingNASH is the use of newer antidiabetic
It is important to stress that there are cur-
rently no specific therapies for NASH. The
insulin resistance, meaning that the insulin
normally present in the bloodstream is less
effective for them in controlling blood glu-
cose and fatty acids in the blood than it is
for people who do not have NASH. Thenewer antidiabetic medications make the
body more sensitive to insulin and may help
reduce liver injury in patients with NASH.
Studies of these medications—includingmetformin, rosiglitazone, and pioglita-
zone—are being sponsored by the National
they can make a difference. They are also
Institutes of Health and should answer the
helpful for other conditions, such as heart
question of whether these medications are
disease, diabetes, and high cholesterol.
A major attempt should be made to lowerbody weight into the healthy range. Weight
Hope Through Research
loss can improve liver tests in patients with
of NASH is more research to better under-
extent. Research at present is focusing on
stand the liver injury found in this disease.
When the pathways that lead to the injury
are fully known, safe and effective means
improvement lasts over a period of time.
can be developed to reverse these pathwaysand help patients with NASH. Recent
ical conditions, such as diabetes, high blood
steps by which insulin and other hormones
conditions should be treated with medica-
regulate blood glucose and fat could pro-
NASH or elevated liver enzymes should notlead people to avoid treating these other
Digestive and Kidney Diseases funds theNASH Clinical Research Network,
throughout the United States and a coordi-
nating center at Johns Hopkins University.
betaine. These medications act by reducing
the oxidative stress that appears to increase
inside the liver in patients with NASH.
the locations of the clinical centers are
For More Information
Points to Remember
American Liver Foundation
1–800–465–4837 or 1–888–443–7222
Phone: 1–800–676–9340 or 212–668–1000
well and may not know that theyhave a liver disease.
tion in which the liver is permanentlydamaged and cannot work properly.
once the disease is advanced or cir-rhosis is present.
tests show high levels of liverenzymes or if scans show fatty liver.
small piece of the liver taken througha needle, a procedure called biopsy.
reduce their weight, eat a balanceddiet, engage in physical activity,and avoid alcohol and unnecessarymedications.
NASH. Experimental therapiesbeing studied include antioxidantsand antidiabetes medications.
National Digestive Diseases
2 Information WayBethesda, MD 20892–3570Phone: 1–800–891–5389Fax: 703–738–4929Email: [email protected]
The National Digestive Diseases InformationClearinghouse (NDDIC) is a service of theNational Institute of Diabetes and Digestiveand Kidney Diseases (NIDDK). The NIDDKis part of the National Institutes of Healthunder the U.S. Department of Health andHuman Services. Established in 1980, theclearinghouse provides information aboutdigestive diseases to people with digestivedisorders and to their families, health careprofessionals, and the public. NDDIC answersinquiries, develops and distributes publications,and works closely with professional and patientorganizations and Government agencies tocoordinate resources about digestive diseases.
Publications produced by the clearinghouseare carefully reviewed by both NIDDK scien-tists and outside experts. This fact sheet wasreviewed by Anna Mae Diehl, M.D., JohnsHopkins University; and Brent Tetre, M.D.,St. Louis University.
This publication is not copyrighted. Theclearinghouse encourages users of this factsheet to duplicate and distribute as manycopies as desired.
This fact sheet is also available at www.digestive.niddk.nih.gov.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of Health
NIH Publication No. 04–4921January 2004
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