Clinical Features of NASH

The enlargement of the liver is one of the major symptoms, which is caused by the reduction of fatty acid oxidation in the liver. This results in the accumulation of fat in the liver. Oftentimes, patients with fatty liver feel severe fatigue and frequent discomfort at the liver area. When the condition become more severe as the accumulation of fat increases, other symptoms such as jaundice, abdominal pain, nausea, vomiting, and tender liver will occur. These symptoms can also be a sign of an underlying liver disease that may be exacerbated by the accumulation of fat in the liver.

Most people become aware of the problem only after a formal examination by their physicians. The results may reveal an enlarged liver along with elevated levels of enzymes such as ALT, AST, GGT, and Alkaline phosphate. Usually ALT is usually more elevated than AST since it is a liver specific enzyme. Aside from blood work, sonograms and CAT scans can also detect fatty liver changes and these methods are usually used for clinical diagnosis.

Histologically, fatty changes in the liver cells are the most obvious characterization. There is also liver cell necrosis, mononuclear and polymorphonuclear inflammatory cells infiltration in the liver lobes.  

The following are the summary of the clinical features of NASH:

1. The peak age of onset: 47 ~ 55
2. Gender: Rate in Female > Rate in Male
3. Obesity: 2/3 patients above the standard body weight
4. High blood sugar level and abnormal glucose tolerate test (GTT): 50% ~ 90% patients have diabetes or abnormal GTT.
5. High blood lipids: 30% ~ 90% have high blood lipids  
6. Concurrent mild ALT and AST elevation.