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NASH Complications

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By Editorial Team

3 min read

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

Nonalcoholic steatohepatitis, or NASH for short, is a serious liver condition. It is part of the spectrum of conditions known as nonalcoholic fatty liver disease (NAFLD). NAFLD is the term for liver disease in which fat builds up in the liver. NASH is the more severe type of NAFLD and can lead to complications if left untreated.1,2

The key difference between NAFLD and NASH is the severity of the condition. NAFLD simply involves fat building up in the liver. NASH, however, also involves inflammation and liver cell damage. NASH can lead to a host of complications and medical issues if it is not managed with the right treatment.1,2

Complications of NASH

There are many serious complications linked to NASH, especially if the disease is left untreated. Complications of NASH can include:1,3,4

  • Fibrosis (buildup of scar tissue in the liver)
  • Cirrhosis (when the scar tissue is permanent and irreversible)
  • Liver failure
  • Liver cancer
  • Cardiovascular disease
  • Type 2 diabetes

Fibrosis

The hallmark of NASH is a buildup of scar tissue in the liver. This is known as fibrosis. As fibrosis progresses, it can impair liver function and lead to more severe complications.1,3

Cirrhosis

In advanced stages of NASH, extensive fibrosis can lead to cirrhosis. This is a condition where the liver becomes severely scarred and hardened. Cirrhosis can impair liver function and increase the risk of liver failure and liver cancer. Cirrhosis occurs in about 5 to 12 percent of people with NASH.1,3

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Liver failure

As NASH progresses even further, the liver is unable to perform vital functions like regulating metabolism and removing toxins from the body. This can result in symptoms of liver failure when the liver shuts down. Liver failure is a life-threatening condition that requires urgent treatment. The only cure for liver failure is a liver transplant.1,3

Liver cancer

People who have advanced NASH with cirrhosis are at increased risk for developing hepatocellular carcinoma (HCC), the most common type of liver cancer. NAFLD is the third most common cause of liver cancer.1,3

Cardiovascular disease

Cardiovascular disease (CVD) and NASH often occur together and can make one another worse. People with NASH are more likely to develop CVD, and people with CVD are more likely to develop NASH. This is because the conditions share risk factors like obesity, insulin resistance, inflammation, and high cholesterol. CVD is the most common cause of death among those living with NASH.1,3,4

In addition, drugs called statins that are used to treat CVD may cause your liver enzymes to be abnormal. Talk to your doctor about any medicines you are taking for CVD and how they may impact your liver.5

Type 2 diabetes

Type 2 diabetes and NASH also often occur together and can make one another worse. There are several possible reasons for this relationship. For example, factors that can lead to type 2 diabetes, like being overweight or having obesity, can also lead to NASH.3,4

Also, experts believe that insulin resistance leads to fat deposits in the liver. Insulin resistance is a condition in which the body cannot process insulin efficiently. NASH can interrupt how the body processes insulin, which worsens type 2 diabetes.3,4

How do these complications arise?

Research strongly suggests that several factors and comorbid conditions contribute to the development of NASH.1,3,4

Insulin resistance

Insulin resistance is commonly linked to NASH. It can lead to increased fat buildup in the liver and swelling of the liver. Insulin resistance is a key factor in the development of type 2 diabetes, a main contributor to NASH.1

Inflammation

Chronic inflammation plays a central role in the progression of NASH. It can make liver cell damage worse and lead to fibrosis and cirrhosis.1

Genetic factors

Genetics also may play a role in the development of NASH. Certain genetic mutations (changes) have been linked to an increased risk of developing NASH and its complications.1

Lifestyle factors

Living with obesity, eating an unhealthy diet, not exercising, and having other medical conditions like cardiovascular disease are all major risk factors for NASH. These things contribute to insulin resistance, inflammation, and liver damage.1

Treatment of NASH

Treatment depends on how advanced NASH is. In cirrhosis, the goal of treatment is to keep the condition from getting any worse. In some cases, people with liver failure may require more intense medical treatment, such as a liver transplant.1,3,4

If NASH is caught in the earlier stages, it may be possible to stop or slow down liver damage with the following treatment options.1,3,4

Lifestyle changes

The first step in treating and managing NASH is to adopt certain lifestyle changes. Changes that can help slow down or even reverse disease progression include:1,4

  • A healthy diet
  • Regular exercise
  • Weight loss
  • Monitoring and managing other health conditions

Medicines

Several types of medicine may be used to treat the inflammation associated with NASH. These include:4,6,7

  • Thyroid hormone receptor-beta (THR) agonists
  • Glucagon-like peptide-1 (GLP-1) agonists to manage blood sugar and/or weight loss
  • Medicines for high blood sugar