Liver Foundation of WA | When NAFLD progresses – NASH and beyond
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When NAFLD progresses – NASH and beyond

When NAFLD progresses – NASH and beyond


Non-alcoholic fatty liver disease (NAFLD), a common liver condition where there is a build-up of excess fat in the liver cells, affects an estimated that 5.5 million Australians, including 40% of all adults aged 50 years and above. Left untreated, NAFLD may progress to advanced stages of the disease known as non-alcoholic steatohepatitis (NASH).

  • By Meghan Betts


What is NASH and how does it progress?

NASH includes liver inflammation and damage caused by the accumulation of fat in the liver. Ongoing, intense inflammation can cause liver scarring and thickening, known as fibrosis, which can then progress to cirrhosis following long-term continuous damage to the liver. NASH is one of the leading causes of cirrhosis. This is where scar tissue replaces normal healthy tissue, and irregular bumps (or nodules) form on the liver, replacing the normal smooth tissue and causing the liver to become harder. As healthy liver cells are replaced with the effects of fibrosis and cirrhosis, the liver is unable to function normally and this can result in liver failure.


What are the symptoms?

Similar to simple NAFLD, people with early stages of NASH often have no or few symptoms. Only as the condition worsens are people more likely to experience fatigue, malaise, unexplained weight loss and abdominal pain where the liver is located (lower rind hand side of rib cage). Without symptoms, NASH and it’s associated damage can go unnoticed for many years, and is often only picked up in a routine check up or during a blood test for another matter.


What’s the difference between NAFLD and NASH?

NAFLD encompasses is the early stages of the disease, chiefly the accumulation of fat in the liver, whereas NASH is the term for the advanced form the includes liver inflammation. NAFLD is generally regarded as benign (harmless) whereas NASH is a more developed condition that can result in significant liver damage and lead to cirrhosis.


In terms of disease progression, the stages are as follows:

  1. NAFLD
  2. NASH
  3. Fibrosis
  4. Cirrhosis


Why doesn’t everyone with NAFLD develop NASH?

It remains unknown why some people with NAFLD develop NASH and others don’t. A genetic link or an environmental trigger have been suggested however there is currently no conclusive evidence for either hypothesis. Like NAFLD, the most common risk factors for developing NASH include: obesity, insulin resistance and type 2 diabetes, high cholesterol, elevated triglycerides and metabolic syndrome.


What can I do?

There is currently no effective treatment for NASH, although some gains in preventing or reversing the disease can be made through simple lifestyle changes. These include eating a well-balanced diet, exercising regularly, avoiding alcohol and losing weight.



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