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NASH Comorbidities

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: May 2024

Nonalcoholic steatohepatitis (NASH) is a serious liver condition in which fat buildup in the liver leads to inflammation and liver cell damage. NASH is the more severe form of NAFLD (nonalcoholic fatty liver disease).1,2

While NASH itself poses significant health risks as it progresses, its impact on the body is made worse by other medical conditions. When multiple medical conditions occur at the same time, they are known as comorbidities. Understanding comorbidities and their relationship to NASH is crucial for effectively managing and treating the disease.3,4

What are the most common comorbidities of NASH?

There are many comorbidities that people with NAFLD and NASH live with. Common comorbidities of NAFLD and NASH include:3,4

  • Obesity
  • Type 2 diabetes
  • Hepatitis C (HCV)
  • Cardiovascular disease (CVD)
  • Chronic kidney disease (CKD)

Obesity

Obesity is a major risk factor for the development and progression of NASH. Excess body weight, particularly visceral fat around the stomach, contributes to fat buildup in the liver, insulin resistance, and inflammation in the liver. These effects lead to NASH progression. Experts widely recommend losing weight as a way to reduce the risk of NASH.3,4

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Type 2 diabetes

Type 2 diabetes and NASH often go hand in hand. In fact, people with NAFLD have twice the risk of having type 2 diabetes than those without liver disease. And research shows that NAFLD is more severe in people with type 2 diabetes.3,5

Insulin resistance plays a central role in both type 2 diabetes and NASH. This is when cells in the body do not respond as they should to insulin. Elevated blood sugar levels that occur with diabetes can worsen liver damage and inflammation. This, in turn, worsens NASH. NASH can also worsen insulin resistance, creating a vicious cycle.3-5

Hepatitis C

People with hepatitis C are at increased risk for developing NAFLD and NASH. While it is more common for people with HCV to develop NAFLD, 4 to 10 percent of people with HCV develop NASH.6

Hepatitis C can speed up the progression of liver fibrosis in NASH. This leads to more severe liver damage and complications. Liver disease is especially taxing on those with HCV genotype 3. Research has found that liver disease progresses more quickly and death rates are higher in those with HCV genotype.3,6

Cardiovascular disease

Cardiovascular disease includes a spectrum of heart diseases like stroke, high blood pressure, and high cholesterol. NASH and CVD share many common risk factors, so they often coexist. These risk factors include obesity and type 2 diabetes.3,4

Having NASH increases a person’s overall risk for CVD. Chronic inflammation and extra stress on the body from NASH worsen heart health. They contribute to plaque buildup in arteries and impair blood circulation throughout the body.2-4

On the other hand, CVD can worsen liver function in people with NASH. This leads to faster disease progression and poorer health outcomes. In fact, CVD is the most common cause of death in people with NASH.2-4

Chronic kidney disease

Just like the other diseases listed above, CKD often occurs alongside NASH. Studies show that people with liver scarring (fibrosis) have more than double the risk of developing CKD than those without scarring.3

Managing comorbidities for better NASH control

Managing comorbidities is essential for preventing NASH from getting worse and reducing the risk of complications. Lifestyle changes like regular exercise and a healthy diet play a central role in managing obesity, type 2 diabetes, CKD, and CVD.1,3

Weight loss is often a very effective treatment method for many of these comorbidities. Reaching a healthy weight can improve insulin resistance, reduce the buildup of fat in the liver, and slow down NASH progression.1,3

Certain medicines can also help manage these conditions. For example, drugs called statins may help with high blood pressure and high cholesterol, which are both types of CVD. Insulin drugs may be necessary to control type 2 diabetes.1,3

The overall goal of NASH treatment is to prevent the disease from getting worse and reduce the risk of complications. To ensure their liver health does not get worse, people with NASH should visit their doctor regularly for:1

  • Routine liver function tests
  • Routine blood tests
  • Imaging tests
  • Liver biopsies, if necessary

NASH is often called a “silent disease.” This is because symptoms are often not noticeable until the later stages of the disease. That is why staying on top of your health is so vital. Get regular health checkups, monitor your liver health, and get screened for comorbidities.1,2