The why and how of NASH

If you’ve been diagnosed with NASH (non‑alcoholic steatohepatitis), you may be wondering: How did this happen? While things you can control—like your diet and lifestyle—can result in fat buildup in your liver, having NASH may be influenced by other factors too, such as age, ethnicity, and even gender. Some people may just be more likely to develop NASH than others. In fact, it’s possible to be diagnosed with lean NASH, which is when someone has NASH even though they’re not overweight.

The good news is that no matter how or why you developed NASH, there are things you can do now to manage it.

NASH and other health risks

The underlying cause of NASH is not clear. However, if you’re living with NASH, there’s a good chance you might also be managing type 2 diabetes, high cholesterol, high blood pressure, obesity, or a related condition. Even though type 2 diabetes, high cholesterol, and obesity are not known causes of NASH, having one of them can put you at a higher risk for NASH.

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NASH is often silent

You might find that you’ve been diagnosed with NASH but have no symptoms. NASH often has no specific symptoms until it has progressed (gotten worse) to an advanced stage. In fact, some people live with NASH for years without knowing they have it. If you’re living with NASH, talk to a liver specialist to find out if it’s progressing. If you’re not yet working with a liver specialist, find one here.

NASH progresses at different rates for different people. It can continue to worsen over time and may result in liver scarring, known as fibrosis. Even if you're experiencing no symptoms at all, your liver damage could be getting worse, so it is important to stay informed and learn what you can do to help manage NASH.

Want to know where you stand right now?
Find out your level of NASH progression by talking to your doctor. Fill out a NASH doctor discussion guide before your next doctor visit to make sure you’re asking all the right questions.

You may experience the following

As fibrosis due to NASH progresses, these are usually among the first symptoms to appear:

  • Tiredness/
    fatigue
  • Weight loss
  • Weakness
  • Itching
  • Pain in the upper right abdomen

Remember: Even if you’re not experiencing any of the symptoms above, your liver damage could be getting worse. If no action is taken to slow, stop, or reverse progression of fibrosis due to NASH, your liver could become so damaged that it may not be able to do its job. This could lead to severe, life‑changing health issues, such as cirrhosis (extreme scarring or hardening of the liver). At this point, the following symptoms may appear:

  • Bleeding and bruising
  • Jaundice (yellowing of the skin and eyes)
  • Spider veins
  • Ascites (a buildup of fluid in the abdomen)
  • Esophageal varices (enlarged veins in the throat that can rupture and bleed)
  • Hepatic encephalopathy (confusion, drowsiness, slurred speech)

Whether you’re experiencing symptoms or not, it’s important to take steps now to minimize the impact of NASH and lower the risk of serious liver damage.