NASH

What is Nonalcoholic Steatohepatitis (NASH)?

Non-alcoholic fatty liver disease ( NAFLD ) is an accumulation of fat in the liver.

When this results in inflammation, we term this non alcoholic steatohepatitis ( NASH ). If left unchecked and untreated, it may even lead to scarring as a result of repeated inflammation and eventual liver cirrhosis. NASH is emerging as one of the top causes of liver cirrhosis worldwide.

The effects of NASH is akin to the kind of damage caused to the liver through heavy prolonged drinking, it is just that, this occurs to people who do not abuse alcohol (1).

Who are at risk?

Some of the typical but not-restricted-to factors that constitute to NASH include (1):

1. Obesity

2. Diabetes

3. High cholesterol and high triglycerides

4. Metabolic syndromes ( Defined as the presence of any three of the following: large waist size, high triglycerides in the blood, abnormal levels of cholesterol in the blood, high blood pressure and higher than normal blood glucose levels )

NASH is more likely to occur in adults than children, diabetics or those who have subcutaneous fat concentrated around the abdomen area (3).

What are the symptoms? (3)

What is more sinister about NAFLD and NASH is that often there are no symptoms. The patients are generally well. Some of the symptoms if they do present includes:

1. Fatigue

2. Ache in the upper right abdomen

In severe cases when cirhosis develops, some symptoms you may experience includes:

1. Swelling around the abdominal area

2. Bigger vessels underneath the skin surface

3. Formation of bigger breast in men

4. Swelling of the spleen

5. Red palms

6. Jaundice

Diagnosis (3)

Most of the time, NASH does not exhibit any glaring symptoms, as such, they are very often diagnosed only in health screening.

Some methods used for diagnosing NASH include blood tests, imaging procedures (CT scan, MRI, ultrasound etc) and tissue biopsy.

Often, NASH is only diagnosed during health screenings, as it does not exhibit symptoms most of the time.

Treatment (1)

Treatment for NASH/NAFLD involves generally lifestyle modification and adopting a healthy lifestyle:

1) Achieve a healthy BMI. By shedding 3% to 5% of total bodyweight can bring forth significant benefits. By losing up to 10% of more actually reduces the inflammation in the liver. However do note that weight loss should be achieved gradually and in a sustainable way. Sudden fasting or Very low caloric diet may actually make NAFLD/NASH worse.

2) Stop or moderate on alcohol consumption

3) Regular exercise with the aim of daily net calorie defecit and gradual weight loss of 0.5kg/week

4) Choose food with low glycemic index, avoid sugary drinks and avoiding trans fat in processed food.

Conclusion

A disease once considered for the middle aged who abuse alcohol, fatty liver disease has been on the rise amongst the younger generation who consume little or no alcohol (4). It is, thus, important to consider undergoing health screening on a regular basis and engage in activities that are crucial in maintaining a healthy lifestyle, such as eating right and keeping up with an active workout regime.


Adopting an active and healthy lifestyle is the best medicine to combat chronic illnesses. Dr Chen hopes to share this notion with the masses and inculcate theage old adage “prevention is better than cure”.​

Dr Chen Yiming is the Medical Director of CSKHealth, an initiative that aptly combines comprehensive health screening with customised, post program follow up measures to cater to individual needs.

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References :

1. Nonalcoholic Steatohepatitis (NASH) - Topic Overview. (n.d.). Retrieved June 21, 2017, from http://www.webmd.com/digestive-disorders/tc/nonalcoholic-steatohepatitis-nash-overview#1

2. Matthew, H. (2017, March 13). Picture of the Liver. Retrieved June 21, 2017, from http://www.webmd.com/digestive-disorders/picture-of-the-liver#1

3. Nonalcoholic fatty liver disease. (n.d.). Retrieved June 21, 2017, from http://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/home/ovc-20211638

4. Cheong, T. (n.d.). Retrieved June 21, 2017, from https://www.healthxchange.sg/digestive-system/liver/fatty-liver-disease-rise-singaporeans

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