Non-alcoholic steatohepatitis (NASH)

Non-alcoholic steatohepatitis (NASH) is the more severe form of non-alcoholic fatty liver disease. The term ‘steatohepatitis’ means a fatty liver with inflammation or, in other words, ongoing damage similar to that of alcoholic liver disease. In the cases of NASH, this occurs in those who do not drink alcohol or drink in moderation.

Difference between NASH and NAFLD

Non-alcoholic fatty liver disease (NAFLD) is a very common condition in North America. It is estimated that 20% of the Canadian population has NAFLD and that approximately 4% of Canadians have NASH. While a simple fatty liver is a rather benign condition, NASH is often associated with ongoing liver damage and can lead to cirrhosis of the liver, liver cancer, and the need for a liver transplant.


Obesity is the condition most often associated with NAFLD and NASH.

Besides obesity, nutritional causes of NAFLD and NASH are:

  • Starvation and protein malnutrition
  • Long term use of total parenteral nutrition (a feeding procedure that involves infusing nutrients directly into the blood stream)
  • Intestinal bypass surgery for obesity
  • Rapid weight loss

Certain conditions often accompany and may contribute to fatty liver disease:

  • Diabetes mellitus
  • Hyperlipidemia (elevated fat levels in the blood)
  • Insulin resistance and high blood pressure

Other causes include:

  • Genetic factors
  • Drugs and chemicals


In general, people with NAFLD and NASH have no symptoms. However, some people report discomfort in the abdomen at the level of the liver, fatigue, a general feeling of being unwell, and vague discomfort.


NAFLD and NASH are usually suspected in people who are overweight and obese (particularly those with a large waist circumferences), who have evidence of dyslipidemia (high cholesterol and lipids in the blood), insulin resistance and/or abnormal liver tests. An ultrasound or Fibroscan® of the liver can show the presence of a fatty liver. In some cases, your doctor may advise a liver biopsy, a procedure where the physician inserts a needle into the liver and extracts a sample tissue, which is then examined under a microscope.


Optimal treatment for NASH has not yet been established. It is usually recommended that people avoid drinking alcohol since it is another cause of NAFLD. People are asked to address their risk factors for NASH i.e. to improve their glucose control if they are diabetic and achieve a sustained weight loss.

Currently, there is no proven treatment with medication for NASH. Since it is now such a common condition, NASH has raised much interest in the scientific community. There are now a number of clinical trials looking at various treatments of NASH.

What could happen to people with NASH?

The long-term outlook of people with NASH is not well understood. In most cases, NASH seems to be a slowly progressive disease. However, there are certainly a small proportion of people living with NASH that will progress to cirrhosis, liver cancer and ultimately, liver failure.


National Help Line:
This support resource gives you and your loved one somewhere to turn for answers after diagnosis, helps you understand your disease, and provides you with the resources you need.  You can call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST.

The Peer Support Network:
This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like you who have a family member who has liver disease, who care for someone who suffers from liver disease, or who have been diagnosed with a liver disease, to talk about your concerns with a peer in a similar situation.

If you would like to be connected with a peer supporter in your area, or would like to join the peer support network, please call the National Help Line at 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST or email us.

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