About NASH and liver fibrosis

What is NASH and liver fibrosis?

Non-alcoholic steatohepatitis, or NASH, is usually described as a more severe form of non-alcoholic fatty liver disease (NAFLD). In NAFLD, fatty deposits build up in the liver, but in NASH, inflammation and cell damage are also present, with or without liver fibrosis.
Liver fibrosis is when there is a build-up of scar tissue resulting from on-going inflammation and liver cell death in chronic (long-term) liver disease. Fibrosis may not show symptoms, but it can lead to severe scarring and cirrhosis of the liver, which may not be symptomatic until a late stage of disease.

What are the symptoms of NASH and liver fibrosis?

The early stages of NASH often show no symptoms; most people are unaware that they have it. As NASH progresses, you might start to experience symptoms such as:

  • Fatigue
  • Weight loss without reason
  • Muscle weakness
  • Pain or an ache in the upper abdomen

Liver fibrosis itself does not cause symptoms, but symptoms may arise if it progresses to cirrhosis. These could include:

  • Bleeding easily
  • Fatigue
  • Bruising easily
  • Itchy skin
  • Yellow discoloration of the skin and eyes (jaundice)
  • Fluid accumulation in the abdomen
  • Loss of appetite
  • Nausea
  • Swelling in the legs
  • Weight loss (unexplained)
  • Others

How do we diagnose NASH?

No single test can diagnose NASH. Your physician will ask many questions and assess other health problems you may have, as well as look at your medical history.

To assess whether fat is building up in the liver, your physician may carry out tests such as:

  • Blood tests
  • Abdominal ultrasound
  • A CT scan
  • An MRI scan
  • A Transient Elastography scan (a non-invasive scan which checks for liver stiffness)
  • Liver biopsy to ensure you have NASH (taking a small sample of liver tissue and looking at it under a microscope)

Who is at greater risk of having NASH and liver fibrosis?

The risk factors associated with NAFLD and NASH include, but are not limited to:

  • Being older (the risk increases with age)
  • Having Type 2 diabetes
  • Being overweight or obese
  • Having high triglycerides

What lifestyle choices can help with NASH?


Maintaining a healthy weight is very important. If you are currently overweight or obese, trying to get closer to a healthy weight can improve your overall health and help to manage NASH.


Try to follow a healthy and balanced diet, including plenty of green, leafy vegetables. You should try to watch how much fat and sugar you have, limiting this to healthy fats (fish, nuts, avocado) and natural sugars (fruits) where possible.


Try to get as much regular, moderate-intensity exercise as possible. This can help with weight loss and overall health, including lowering blood pressure and triglyceride levels.

Alcohol and Medication

Try to avoid excessive alcohol consumption as well as any unnecessary medications, as both can place additional strain on the liver.