Non-alcohol related steatohepatitis
(NASH)
NASH is the accumulation of fat – mainly
triglyceride, cholesterol and phospholipids– over 5-10% of liver weight. The term “nonalcohol
related fatty liver disease” was introduced
to explain the varying degree of
severity of liver fibrosis in patients not
exposed to alcohol. NASH is the more
severe form and can progress over years to
cirrhosis; it now accounts for 10-20% of all
cases of cirrhosis (Dooley et al, 2011). NASH
is part of a metabolic syndrome that
includes obesity (although not all patients
are obese), diabetes mellitus, hypertension
and cardiovascular disease; these comorbidities
may complicate care.
Treatment of NASH is aimed at weight
loss and dietary intake, tight control of
blood glucose in patients with diabetes,
and management of hyperlipidaemia and
hypertension. A multiprofessional team
approach, with dietitians, diabetes specialist
nurses and NASH pathways
between primary and secondary care, optimises
treatment outcomes.