Fast Five Quiz: Nonalcoholic Steatohepatitis (NASH)

B.S. Anand, MD


May 11, 2020

The three conditions that are central in establishing the diagnosis of NASH in adults are steatosis, hepatocyte injury, and a unique pattern of fibrosis resembling "chicken wire" that is accentuated in zone 3.

Metabolic syndrome, which includes type 2 diabetes, obesity, high blood pressure, and hypertriglyceridemia, is the condition most commonly associated with fatty liver disease; however, it is not necessary for a diagnosis. There have been reports of NASH in patients from relatively lean families. In fact, it has been observed that Asian patients in particular may develop NAFLD and NASH despite body mass indexes in the normal range.

Liver fibrosis or cirrhosis is present in 15%-50% of patients with NASH. Out of the patients with fibrosis, about 30% develop cirrhosis within 10 years. Although the injury pattern of NASH in adults is centrally located—with inflammation accentuated in zone 3—in children, an injury pattern centered in zone 1 has been documented.

Learn more about the diagnosis of NASH.


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