A NASH Nurse Answers Patients' Most Common Questions

If you’ve spent any time in the healthcare world, you’ve probably realized pretty quickly that we healthcare providers often use an entirely different language. The gap between what’s being said by your medical provider can be confusing at best. At worst, that gap can make it hard to follow their recommendations. So, as a healthcare provider, I'd like to help bridge that gap.

Why is NASH now sometimes called MASH?

Whether you’re attending a doctor’s appointment, reading online information, or reviewing your medical chart, your liver disease has probably been described several different ways. NASH stands for nonalcoholic steatohepatitis.

NASH is a more severe form of non-alcoholic fatty liver disease (NAFLD). In years past, fatty liver disease was separated by whether it was caused by alcohol misuse or not. It was not well understood what caused NAFLD. While we still don’t have all the answers, growing research connects the risk for NAFLD to your body’s metabolic health.^1,2

Metabolic health is how well your body uses and stores glucose (sugar) and fat. If your body struggles to do this, it’s called metabolic syndrome. People with metabolic syndrome have at least 3 of the following:^1,2

• Excess body fat around the waist
• High triglycerides (a certain type of fat in the blood)
• Low HDL ("good" cholesterol) levels
• High blood sugar
• High blood pressure

Steatohepatitis describes a condition where your body has too much fat (steato) in and around the liver, causing inflammation (hepatitis). You also may hear the words fibrosis or cirrhosis. Fibrosis is a hardening or stiffening of your liver tissue that leads to scarring. Scarred liver tissue begins to replace healthy liver tissue, making it more difficult for the liver to work well.

In some cases, fibrosis can be stopped or even reversed. If the scarring becomes severe or permanent, it’s called cirrhosis.¹

Because of the links between metabolic syndrome and steatohepatitis, NASH is now often called metabolic-dysfunction-associated steatohepatitis (MASH).^1,2

I see so many specialists...who’s who?

Seeing specialists is likely part of your medical care if you have NASH/MASH. You may see a gastroenterologist. This is a doctor who specializes in medical conditions of your digestive tract, including the liver, pancreas, intestines, and stomach. These doctors are sometimes called “GI doctors.”¹

You may also have a hepatologist on your team. A hepatologist has usually also studied gastroenterology but narrows their focus on just the liver, bile ducts, and sometimes the pancreas.¹

If your NASH/MASH has affected other body areas, such as your kidneys, you may also see a doctor who specializes in kidney health. This doctor is called a nephrologist.¹

NASH doesn’t happen in a vacuum. It’s common to see specialists for other chronic diseases that appear with steatohepatitis. It can be tricky to keep track of who’s who. Having a system for writing down instructions and questions you have, and clarifying who to call with what concerns can help.

It’s also important to talk with your primary care provider about when and why you may be referred to one or more of these doctors.

Is my treatment plan working?

One of the best ways to know if your treatment plan is working is by looking at your blood work. Having a basic understanding of what’s being checked, the healthy range for that test, and your own results can go a long way. Common tests that are used in NASH/MASH are:¹

• Lipid panel – A lab test that shows your cholesterol results, such as LDL, HDL, and triglycerides.
• Total bilirubin – This is a test showing how much bilirubin is in your blood. Bilirubin is a yellow substance that comes from the breakdown of red blood cells and is processed through your liver. High bilirubin is a sign the liver is not working well. Your doctor may test for direct bilirubin or total bilirubin.
• Liver function tests (LFTs) – Lab tests that can show liver damage or inflammation. LFTs are also called liver enzyme tests. Common liver enzymes checked are AST (aspartate aminotransferase) and ALT (alanine aminotransferase). These results can also show up on a lab called a comprehensive metabolic panel. Other enzymes your provider may check include ALP (alkaline phosphatase), GGT (gamma-glutamyl transferase), LD (lactate dehydrogenase).
• Fibrosis 4 (Fib-4) score or AST-to-platelet ratio index (APRI) – A test to estimate the amount of scarring that’s developed in your liver. Some people can have normal liver function tests with NAFLD or MASLD, so Fib-4 and/or APRI scores are an important part of your exam.
• Liver biopsy – A tissue sample taken from your liver. This can help determine how much scar tissue your liver has as well as explore potential causes of your liver disease. Not everyone needs a biopsy for their care.