NASH is generally a “silent disease” with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss and weakness—once the disease is more advanced or cirrhosis develops. Up to 15 percent of patients with NASH may progress to cirrhosis of the liver.
Currently there is no evidence-based clinical practice guideline for NASH. The European Association for the Study of the Liver published a position statement on NASH that includes the following:
- Weight loss, physical exercise, reduction of sedentary lifestyle and dietary changes should be the first line of treatment in all patients with NASH.
- Certain dietary components such as high-fructose corn syrup and trans-fats may increase the risk of NASH and should be limited or avoided.
- There is no evidence that alcohol avoidance is beneficial. In fact, modest wine drinking (less than 1 glass per day) has shown possible protective effects.
- Medication and/or bariatric surgery may be possible treatment options.
Because NASH is commonly associated with hyperlipidemia, obesity and insulin resistance, these health issues would need to be addressed in managing the disease. According to the National Institutes of Health, general recommendations might include: gradual weight loss, following a balanced and healthy diet, increasing physical activity, and avoiding alcohol and unnecessary medications. However, more research is needed to develop and evaluate nutritional guidelines.