Figure 1: Weight Loss as a Cure for NASH. A small prospective cohort study showed that weight loss was associated with a significantly higher rate of NASH resolution. Among the 19 patients who had lost more than 10% of their body weight over the 4.6 years of the study, 12 patients had achieved fibrosis regression, where their fibrosis begins to go away. Among the 22 patients who did not reach this level of weight loss, only 2 achieved fibrosis regression. This was highly significant with an adjusted OR of 8.14 and a p-value of less than 0.001.
Fundamentally, NASH is a disease that is driven by weight gain and diet. The causes of NASH are similar in many ways to diabetes. When we eat poorly and eat too much, fats can build up in the liver. Over time, this fat causes the liver to become inflamed and scarred, which is what we know of as NASH.
Therefore, it is not surprising that in some patients, significant weight loss may be enough to resolve NASH. By removing the fundamental cause of NASH, some patients may be able to improve their symptoms and reverse NASH without medication.
One study found that 63% of patients who lost more than 10% of their body weight over just under 5 years achieved fibrosis regression, where their fibrosis began to get better. This was significantly more likely than in patients who did not lose more than 10% of their body weight.
Figure 2: Vitamin E as a NASH Treatment. A large clinical trial with 247 patients showed that Vitamin E and pioglitazone can both potentially reverse and even cure NASH. 37% of patients who took vitamin E achieved NASH resolution. 47% of patients who took pioglitazone achieved NASH resolution.
Surprisingly, vitamin E may be effective in reversing NASH in some patients. A randomized clinical trial found that 37% of patients who were given vitamin E achieved NASH resolution, which was significantly more than the placebo control.
Vitamin E is a known antioxidant, and it is believed that vitamin E may reduce the oxidative stress in the liver.
In the same trial, researchers also found that a common diabetes medication, pioglitazone, also increases the odds that a patient will achieve NASH resolution.
Source: Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis
Figure 3: NAFLD: Mortality with Fibrosis. The risk of mortality in NAFLD depends highly on whether a patient has fibrosis. Patients with fibrosis had a dramatically higher risk of mortality. As shown above in red, nearly all patients with fibrosis had passed away by the end of the study. Meanwhile, patients with fatty liver and no fibrosis had a survival rate approximately equivalent to patients without fatty liver.
Fatty liver by itself, without NASH, is not necessarily fatal. As you can see in the chart above, patients with fatty liver without NASH had nearly the same survival as healthy patients. Patients with NASH had significantly lower survival.
In this particular study, only 50% of patients with NASH were still alive with their original liver by year 10. Meanwhile, patients with NAFLD without Nash had just about the same odds of survival as healthy patients.
Figure 4: NASH is a late stage of of NAFLD. Not all NAFLD is NASH. NASH is associated with significantly higher mortality, while NAFLD without NASH is not. NASH carries a high risk of cancer as well. Fortunately, NASH is much less common than NAFLD as a whole. Livers with NASH often include inflammation and scarring. Livers with NAFLD, in general, are characterized by the presence of fat in the liver.
For reference, we have summarized the key differences between NASH and NAFLD above. NASH is a subset of NAFLD. All patients with NASH have NAFLD by definition, however most patients with NAFLD do not have NASH.
