What is NASH?
Non-Alcoholic Steatohepatitis (NASH) is the most severe form of Non-Alocoholic Fatty Liver Disease (NAFLD), a highly underdiagnosed cause of severe liver complications. NAFLD is estimated to affect nearly 80 million people in the US, but only 5% are aware they have liver disease.
Risk Factors
NAFLD/NASH is highly associated with other metabolic co-morbidities, including type 2 diabetes, hypertension, dyslipidemia, and excess weight (obesity). An estimated 30% to 40% of the US adult population is currently affected by NAFLD.
Progression to NASH
NASH is a severe form of NAFLD characterized by liver cell inflammation injury, known as ballooning. This can lead to a type of scarring called fibrosis in the liver.
Creating a Care Plan
Patients with NASH and significant fibrosis (F≥2) are considered to have a higher likelihood of progression to cirrhosis, liver failure, and hepatocellular carcinoma (HCC), and may benefit from future pharmacotherapeutic interventions.
Regular MRI exam that can't see liver fibrosis
MR Elastography exam showing areas of fibrosis (in red)
Diagnosis
NASH is a complex disease that requires doctors to know about three critical components of liver health: Liver Fat, Liver Fibrosis and Liver Inflammation. To get a good idea of each of these without liver biopsy, physicians rely on a combination of MRI biomarkers and blood tests.
Parameter
Liver Fat
MRI-PDFF
Measured by:
Liver Fibrosis
MR Elastography
MRI exam
Liver Inflammation
AST/ALT/FIB-4
Blood work
Together, these markers of disease activity can be very accurate for ruling-in NASH and assessing its severity. Clinicians should pay particular attention to the degree of fibrosis. This is measured by the MR Elastography (MRE) exam, which was invented at Mayo Clinic. Severe liver fibrosis is the one parameter of liver health that is linked to adverse liver outcomes (e.g., cirrhosis).
NASH Scoring
There have been a number of scoring systems created to help diagnose NASH. These scoring systems have been studied extensively and developed to rule-in or rule-out NASH and develop an appropriate and personalized care plan. You can use the calculator here to automatically calculate your patient's risk of NASH using these scoring systems.
For more information on these scoring systems, visit:
Noureddin, M., Truong, E., Gornbein, J. A., Saouaf, R., Guindi, M., Todo, T., Noureddin, N., Yang, J. D., Harrison, S. A., & Alkhouri, N. (2021). MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis. Journal of hepatology, S0168-8278(21)02184-X. Advance online publication. https://doi.org/10.1016/j.jhep.2021.11.012
Jung, J., Loomba, R. R., Imajo, K., Madamba, E., Gandhi, S., Bettencourt, R., Singh, S., Hernandez, C., Valasek, M. A., Behling, C., Richards, L., Fowler, K., Sirlin, C. B., Nakajima, A., & Loomba, R. (2021). MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut, 70(10), 1946–1953. https://doi.org/10.1136/gutjnl-2020-322976
What does this scale denote?
low-risk of NASH with fibrosis (>F2)
indeterminate
high-risk of NASH with fibrosis ≥F2
If Your Patient Is at High Risk for NASH
If you suspect your patient has NASH with fibrosis, there are treatment options.
Most cases of NASH can be treated with life style changes (including diet and exercise regimens) and/or prescription medicines.
coulditbeNASH.com is supported by Resoundant. Other NASH scoring systems may be used by clinicians.
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This webpage encludes Clinical Decision Support Software and is exempt from regulation by the FDA under 21 U.S.C. 360j(o). By using this software, the user acknowledges and agrees that he or she is a health care professional experienced in diagnosing liver disease. The software only supports or provides recommendations to a health care professional, who must not rely primarily on any such recommendations to make a clinical diagnosis or treatment decision regarding an individual patient and who may independently review the basis for such recommendations. The user is solely responsible for any final decision regarding the condition of any individual patient. The user agrees to indemnify and hold harmless Resoundant from any costs, expenses, damages, or other liabilities resulting from any claims relating to use of the software.
