FAQs:

What causes nonalcoholic fatty liver disease and NASH?
Nobody really knows the exact cause, but there are clear associations with certain conditions:

• Increased body mass index/obesity
• Diabetes mellitus, which causes increased blood sugar levels
• High cholesterol
• Certain medicines

What are the symptoms of NASH?
Most people with NASH have no symptoms. It is often an incidental finding when you have blood tests or an abdominal ultrasound or scan.

Will I need more tests?
Yes. If your doctor or nurse suspects that you have NASH, you will likely have:

• Further blood tests
• An imaging test of the liver, such as an ultrasound, CT, or MRI scan – Imaging tests that better visualise the internal organs

Some people need a liver biopsy. During this test, the doctor removes a small sample of tissue from the liver and sends it to theathologist perform a microscopic assessment of the liver sample, to confirm the diagnosis of fatty infiltration and assess for inflammation. A liver biopsy is the only test that can tell for sure if you have NASH. Your doctor might do this test if he or she is not sure if you have NASH or to see how much inflammation there is in the liver. If your blood tests and imaging tests are normal you will not need a liver biopsy.

How is nonalcoholic fatty liver disease and NASH treated?
NASH is not treated directly. But the condition can get better when other medical conditions that often happen with NASH get treated. For example, losing weight, and controlling high blood sugar and cholesterol can help improve NASH. With help from your doctor and dietician you can:

• Create a weight loss planif you are overweight It is important to lose weight slowly. Do not lose more than 1.6 kilogramsa week. A little bit of regular exercise can make a big difference. Exercise also helps control sugar levels in people with type 2 diabetes (non-insulin dependent).
• Treat your high blood sugar, if you have high blood sugar. Once again diet and weight control play an important role here.
• Treat your high cholesterol, if you have high cholesterol.

If you take medication that could be causing NASH, this medication might need to be stopped. This will be done in consultation with your doctor and gastroenterologist/physician. Sometimes vitamin E is added as an anti-oxidant, as some studies have shown that vitamin E can reduce liver inflammation.

Does NASH get worse over time?
NASH does not usually get worse over time. But sometimes it leads to serious scarring of the liver, called "cirrhosis." Cirrhosis is more serious, as this means that the liver scarring is irreversible. Our aim is to try to prevent liver cirrhosis. There are different treatment options if you have liver cirrhosis, to prevent complications and progression of liver damage.

Do I need regular follow up with my doctor?
Yes. People who have NASH need to see their doctor for regular check-ups. Your doctor will do follow-up tests on a regular basis. These usually include blood tests.