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What is the difference between fatty liver and NASH?



NAFLD is the most common liver disease in Western countries. It affects between 17% and 46% of adults. NAFLD is a term that covers the entire range of fatty liver disease, from isolated steatosis to NASH. The main characteristic of people suffering from NAFLD is the accumulation of fat in their liver. A healthy liver has no more than 5% of fat. While the fat buildup in the liver is often the result of alcohol abuse, NAFLD is not the result of alcoholism.


NAFLD is more commonly found in people who have certain conditions such as metabolic syndrome, obesity and related diseases such as type 2 diabetes. It is considered the consequence of a certain lifestyle. Simple fatty liver and nonalcoholic steatohepatitis (NASH) are two distinct diseases, two types of NAFLD. It is not clear why some people develop fatty liver and others develop NASH.


Simple fatty liver is a form of NAFLD. People suffering from fatty liver have excess fat built up in their liver but very little or no inflammation or cell damage. Simple fatty liver normally does not cause liver damage or complications.


NASH is a form of NAFLD that not only causes the accumulation of fat in the liver but also causes hepatitis—inflammation of the liver—and the damage to the liver cells. Inflammation and liver cell damage often cause scarring of the liver or fibrosis. NASH also may cause cirrhosis of the liver or liver cancer.


NASH is the most severe form of NAFLD. In its early stages, its symptoms are often silent or non-specific, making it very difficult to diagnose. Often, the only way to surely diagnose NASH is liver biopsy. For that reason, NASH patients can be unaware of their deteriorating condition until their disease reaches its late stages. NASH may progress to more serious stages of the disease such as advanced fibrosis, liver failure, cirrhosis, liver cancer, caused by inflammation and hepatocellular ballooning. Almost 38% of patients with NASH die from heart failure.


Patients with NASH-related cirrhosis are at higher risk of terminal liver diseases, such as loss of liver function, liver failure, and liver cancer.


Weight loss is the most common treatment for all forms of nonalcoholic fatty liver disease (NAFLD) – simple fatty liver and NASH. Weight loss can reduce fat in the liver, reduce inflammation and fibrosis, even scarring. Losing at least 3% of body weight can reduce fat in the liver, but to reduce liver inflammation patients need to lose up to 10% of body weight.


No medication is recommended for the treatment of fatty liver or NASH. The meds are recommended only to treat underlying conditions such as diabetes or heart disease.

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