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A person draws 2 livers on a chalk board

Understanding the Differences and Similarities Between NAFLD and NASH

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By Editorial Team

3 min read

When it comes to liver health, there are 2 conditions that you should be aware of: nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Both of these conditions are related to fat buildup in the liver. But they have key differences in terms of severity, potential complications, and treatment.1,2

NAFLD versus NASH

Nonalcoholic fatty liver disease (NAFLD) is a condition where fat builds up in the liver. This happens in people who drink little to no alcohol. NAFLD is 1 of the most common liver diseases worldwide.1,2

Nonalcoholic steatohepatitis (NASH) is a more severe form of NAFLD. It is much less common.1

In addition to the fat that builds up in the liver, NASH includes liver inflammation and damage to liver cells. This inflammation can lead to fibrosis, the beginning stage of liver scarring. If left untreated, over time NASH can progress to:1

  • Severe, permanent scarring of the liver (cirrhosis)
  • Liver failure
  • Liver cancer

Similarities

There are many similarities between NAFLD and NASH.1,2

Both are “silent diseases”

Both NAFLD and NASH often show no symptoms in the early stages. This is why they are sometimes considered “silent diseases.” When symptoms do occur, they might include:2

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  • Fatigue
  • Weakness
  • Discomfort or pain in the upper right stomach area

They share comorbidities

NAFLD and NASH share many of the same comorbidities. Comorbidities are health conditions that occur alongside a primary condition. NAFLD and NASH more commonly occur in people who also have:1,2

  • Obesity
  • Type 2 diabetes
  • High cholesterol
  • Metabolic syndrome

They are diagnosed the same way

Diagnosis of NAFLD and NASH involves a combination of medical history, physical exam, and:3

  • Blood tests – By measuring liver enzymes in your blood, your doctor can see how well your liver is functioning.
  • Imaging tests – Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and elastography all can show fat buildup in the liver.
  • Liver biopsy – In this procedure, your doctor takes a small sample of your liver to analyze under a microscope. This is the most sure way to tell whether there is a problem with your liver. It also helps your doctor tell whether you have NAFLD or NASH.

They have similar treatment methods

Treatment methods for NAFLD and NASH focus on lifestyle changes and managing underlying conditions.4

  • Lifestyle changes – Losing weight, eating a healthy diet, and increasing physical activity are the first treatment steps. Reducing weight by 7 to 10 percent can greatly improve liver health.
  • Managing underlying conditions – Both conditions require controlling diabetes, high cholesterol, and high blood pressure. Managing these conditions reduces strain on the liver.
  • Medications – Doctors may prescribe certain medicines to control risk factors such as diabetes and high cholesterol. For example, a drug called resmetirom (Rezdiffra™) has been approved to treat advanced fibrosis resulting from NASH.

Differences

While there are many similarities between NAFLD and NASH, there also are some key differences.

NAFLD can be reversed if action is taken

The hallmark of NAFLD is fat buildup in the liver. There is a lot you can do to get NAFLD under control before more serious damage or inflammation occurs. Primarily, lose weight, eat a healthy diet, and get regular exercise.2,4

NASH involves inflammation and liver cell damage

Unlike NAFLD, NASH involves inflammation and damage to liver cells along with fat buildup. This makes NASH a more serious condition than NAFLD.1,2

NASH has worse outcomes

People with NASH are at higher risk for developing advanced liver disease. They also are more likely to have noticeable symptoms and complications related to liver health.1,2

Early diagnosis and treatment are key

NAFLD and NASH are related liver conditions. But they differ in severity and potential complications. NAFLD is generally a milder condition without inflammation and severe damage. NASH involves inflammation and can lead to serious liver damage if left untreated.1,2

Early diagnosis and lifestyle changes are key to managing both conditions and preventing liver damage from getting worse. If you suspect you might have liver issues, make an appointment with your doctor.1,4

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