Screening for Nonalcoholic Steatohepatitis (NASH)

Nonalcoholic steatohepatitis (NASH) is a serious liver condition. It is a serious type of a broader condition called nonalcoholic fatty liver disease (NAFLD), where fat builds up in the liver. But unlike simple fatty liver, NASH involves liver inflammation and liver cell damage.¹

If NASH is left undiagnosed or untreated, it can progress to more severe conditions like:¹

• Cirrhosis (permanent scarring of the liver)
• Liver failure
• Liver cancer

To date, there are no official screening recommendations for NASH. However, many experts want this to change and are encouraging doctors to screen for NASH. Knowing how and when to screen can help catch NASH earlier and manage it more effectively.^1,2

Who should be screened for NASH?

Certain groups of people are at a higher risk of developing NASH and should consider getting screened. These include people with:^1-3

• Obesity
• Type 2 diabetes
• High cholesterol
• Sleep apnea, a disorder where breathing repeatedly stops and starts during sleep
• Polycystic ovary syndrome (PCOS), a hormonal disorder common among women of reproductive age
• A family history of liver disease

When should a person screen for NASH?

You should consider getting screened for NASH if you belong to one of the high-risk groups mentioned above. You should also consider screening if you experience any of the following symptoms:⁴

• Unexplained fatigue
• Pain in the upper right abdomen, where the liver is located
• Unexplained weight loss
• General feelings of weakness or lethargy

Even if you do not have symptoms, discuss screening with your doctor if you have any of the above risk factors. Early detection of NASH can lead to better overall life expectancy and outcomes.⁴

How is screening for NASH done?

Unfortunately, no one screening test can tell for sure whether you have NASH. Instead, a combination of diagnostic tests is needed. Along with a physical exam and full medical history, these tests gather information and help assess the health of your liver:^1,2

Blood tests

Several blood tests can give a general sense of liver health. From there, doctors can determine whether further tests are needed. Blood tests can also be used to rule out other health conditions, like hepatitis C or a rare genetic disease called Wilson disease. Your doctor might recommend:^1-3

• Liver enzyme tests – These tests check for high levels of liver enzymes, which can indicate liver damage.
• Fasting blood sugar and hemoglobin A1c – This measures blood sugar levels to find diabetes or prediabetes, which are risk factors for NASH.
• Lipid profile – This test measures cholesterol and triglyceride levels. These levels can be higher in people with fatty liver disease.

Fibrosis-4 calculator

The Fibrosis-4 (Fib-4) calculator is a noninvasive tool that estimates liver scarring (fibrosis). Fibrosis is a key sign of liver damage. The Fib-4 calculator uses the following data to assign you a score:^1,5

• Age
• AST (aspartate aminotransferase) – A liver enzyme that, when high, points to liver damage.
• ALT (alanine aminotransferase) – Another liver enzyme that is elevated in people with liver disease.
• Platelet count – Platelets are blood cells. Abnormal levels of them can suggest liver problems.

This information is put into a formula that calculates a score. The higher your score, the greater your risk of fibrosis. The Fib-4 calculator helps healthcare providers determine who may need additional tests, such as imaging or a liver biopsy.^1,5

Imaging

Imaging tools can be useful in showing whether the liver has fat buildup, inflammation, or anything else that is abnormal.^1-3

• Ultrasound – A common, noninvasive test that can see fat in the liver.
• Transient elastography (FibroScan) – This specialized ultrasound measures liver stiffness. Stiffness can indicate fibrosis (scarring) from NASH.
• MRI or CT scan – These imaging tests provide detailed pictures of the liver to detect fat buildup and scarring.

Liver biopsy

If your doctor sees signs of liver stiffness and suspects NASH, a liver biopsy can confirm the NASH diagnosis. A biopsy involves taking a small sample of liver tissue and examining it under a microscope. A liver biopsy is the only definitive way to diagnose NASH.^2,3

Stay on top of your health

In many cases, NAFLD and NASH are preventable. With lifestyle changes (like losing weight, eating well, and exercising) and drug treatment, you can stop liver damage in its tracks or even reverse it.^1,4

If you fall into a high-risk category or have symptoms, talk to your doctor about screening options. Early detection through blood tests, imaging studies, and – if necessary – a liver biopsy can help prevent serious liver complications and improve your overall health.²