non-alcoholic steatohepatitis (NASH); metabolic dysfunction-associated steatohepatitis (MASH)

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Etiology

Epidemiology

  • common disorder
  • most common in middle-aged women
  • common in severely obese individuals[3]

Pathology

Laboratory

Radiology

Complications

Management

More general terms

Additional terms

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 321
  2. Jump up to: 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
  3. Jump up to: 3.0 3.1 Journal Watch 21(15):123, 2001 Dixon JB et al Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121:91, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11438497
  4. Zelber-Zagi S et al, A double-blind randomized placebo-controlled trial for orlistat for the treatment of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2006, 4:639 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16630771
  5. Jump up to: 5.0 5.1 Belfort R et al, A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. NEJM 2006, 355:2361 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17135584
  6. Jump up to: 6.0 6.1 6.2 Ekstedt M, Franzen LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, Kechagias S. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006 Oct;44(4):865-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17006923
  7. Jump up to: 7.0 7.1 Williams CD et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: A prospective study. Gastroenterology 2011 Jan; 140:124 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20858492
  8. Jump up to: 8.0 8.1 8.2 8.3 8.4 8.5 Chalasani N et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012 Jun; 55:2005 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22488764 (corresponding NGC guideline withdrawn Dec 2017)
  9. Jump up to: 9.0 9.1 Vilar-Gomez E et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology 2015 Aug; 149:367. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25865049
    Lassailly G et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology 2015 Aug; 149:379. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25917783
  10. Jump up to: 10.0 10.1 Cusi K, Orsak B, Bril F et al Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized, Controlled Trial. Ann Intern Med. Published online 21 June 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27322798 <Internet> http://annals.org/article.aspx?articleid=2529686
    Vilar-Gomez E, Adams LA Pioglitazone: An Addition to Our Toolbox for Patients With Diabetes and Nonalcoholic Steatohepatitis? Ann Intern Med. Published online 21 June 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27322890 <Internet> http://annals.org/article.aspx?articleid=2529687
  11. Jump up to: 11.0 11.1 Zelber-Sagi S, Salomone F;, Mlynarsky L. The Mediterranean Dietary Pattern as the Diet of Choice for Non-alcoholic Fatty Liver Disease: Evidence and Plausible Mechanisms. Liver Int. 2017 Jul;37(7):936-949 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28371239
  12. Diehl AM, Day C Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis. N Engl J Med 2017; 377:2063-2072. Nov 23, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29166236 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1503519
  13. Jump up to: 13.0 13.1 13.2 NEJM Knowledge+ Question of the Week. Jan 23, 2018 https://knowledgeplus.nejm.org/question-of-week/488/
  14. European Association for the Study of the Liver (EASL);. European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27062661
  15. Jump up to: 15.0 15.1 Bril F et al. Role of vitamin E for nonalcoholic steatohepatitis in patients with type 2 diabetes: A randomized controlled trial. Diabetes Care 2019 Aug; 42:1481 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31332029 https://care.diabetesjournals.org/content/42/8/1481
  16. NEJM Knowledge+ Question of the Week. Dec 15, 2020 https://knowledgeplus.nejm.org/question-of-week/1577/
  17. Jump up to: 17.0 17.1 Newsome PN, Buchholtz K, CusiK et al A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis. N Engl J Med 2021; 384:1113-1124. March 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33185364 https://www.nejm.org/doi/full/10.1056/NEJMoa2028395
  18. Jump up to: 18.0 18.1 Reuters Staff Study Supports Chemopreventive Effect of Statins on Liver Cancer in NASH Cirrhosis. Medscape. July 20, 2021 https://www.medscape.com/viewarticle/954877
    Pinyopornpanish K, Al-Yaman W, Butler RS et al Chemopreventive Effect of Statin on Hepatocellular Carcinoma in Patients With Nonalcoholic Steatohepatitis Cirrhosis. Am J Gastroenterol. 2021. July 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34212895 https://journals.lww.com/ajg/Abstract/9900/Chemopreventive_Effect_of_Statin_on_Hepatocellular.36.aspx
  19. Jump up to: 19.0 19.1 19.2 Sanyal AJ, Van Natta ML, Clark J et al. Prospective study of outcomes in adults with nonalcoholic fatty liver disease. N Engl J Med 2021 Oct 21; 385:1559. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34670043 https://www.nejm.org/doi/10.1056/NEJMoa2029349
  20. Jump up to: 20.0 20.1 Francque SM, Bedossa P, Ratziu V et al. A randomized, controlled trial of the pan-PPAR agonist lanifibranor in NASH. N Engl J Med 2021 Oct 21; 385:1547. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34670042 https://www.nejm.org/doi/10.1056/NEJMoa2036205
  21. Jump up to: 21.0 21.1 Aminian A, Al-Kurd A, Wilson R et al Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis. JAMA. Published online November 11, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34762106 https://jamanetwork.com/journals/jama/fullarticle/2786270
  22. Jump up to: 22.0 22.1 Castera L et al. High prevalence of NASH and advanced fibrosis in type 2 diabetes: A prospective study of 330 outpatients undergoing liver biopsies for elevated ALT, using a low threshold. Diabetes Care 2023 Jul; 46:1354-1362. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37043830 https://diabetesjournals.org/care/article/46/7/1354/148710/High-Prevalence-of-NASH-and-Advanced-Fibrosis-in
    Scoditti E et al. Hunting for progressive NAFLD in type 2 diabetes: Do not trust liver enzymes! Diabetes Care 2023 Jul; 46:1332-1334. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37339349 https://diabetesjournals.org/care/article/46/7/1332/151555/Hunting-for-Progressive-NAFLD-in-Type-2-Diabetes
  23. Jump up to: 23.0 23.1 Harrison SA, Bedossa P, Guy CD et al A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med 2024; 390:497-509. Feb 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38324483 https://www.nejm.org/doi/full/10.1056/NEJMoa2309000
  24. Jump up to: 24.0 24.1 Harrison SA et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med 2024 Feb 8; 390:497. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38324483 https://www.nejm.org/doi/10.1056/NEJMoa2309000
    Loomba R et al. Randomized, controlled trial of the FGF21 analogue pegozafermin in NASH. N Engl J Med 2023 Sep 14; 389:998. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37356033 PMCID: PMC10718287 (available on 2024-03-14) https://www.nejm.org/doi/10.1056/NEJMoa2304286
  25. Rinella ME, Lazarus JV, Ratziu V et al A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023. June 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37364790 Free article. Review. https://journals.lww.com/hep/Fulltext/9900/A_multi_society_Delphi_consensus_statement_on_new.488.aspx
    Loomba R, Wong VW. Implications of the new nomenclature of steatotic liver disease and definition of metabolic dysfunction-associated steatotic liver disease. Aliment Pharmacol Ther. 2024 Jan;59(2):150-156. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38153279 PMCID: PMC10807722 Free PMC article. Review. https://onlinelibrary.wiley.com/doi/10.1111/apt.17846
  26. Jump up to: 26.0 26.1 Bansal S, Bader A, Mahmud N, Kaplan DE. Survival and Cost-Effectiveness of Bariatric Surgery Among Patients With Obesity and Cirrhosis. JAMA Surg. 2025 Apr 2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/40172871 https://jamanetwork.com/journals/jamasurgery/fullarticle/2832074
  27. Jump up to: 27.0 27.1 No authors listed Phase 3 ESSENCE Trial: Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. Gastroenterol Hepatol (N Y). 2024. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39896971 PMCID: PMC11784563 Free PMC article.
    Sanyal AJ, et al. Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. N Engl J Med. 2025. PMID: https://www.ncbi.nlm.nih.gov/pubmed/40305708 https://www.nejm.org/doi/10.1056/NEJMoa2413258

Patient information

steatohepatitis patient information