Understanding NAFLD and NASH

Guest blog by: Monica Morgan, Pharm.D., CSP

As a specialty pharmacy that works with many patients during treatment for liver diseases, it’s not surprising that questions about nonalcoholic fatty liver disease (NAFLD) come up in our line of work. Although hepatitis C is our primary liver focus, both hepatitis C and NAFLD rank as the two most common causes of chronic liver disease. I’ll be sharing here about why NAFLD deserves attention and understanding.

What are NAFLD and NASH?

NAFLD is a serious condition in which abnormal amounts of fat build up inside the liver. It’s likely that lifestyle and diet contribute to this process. Nonalcoholic steatohepatitis (NASH) is a type of NAFLD that causes inflammation and liver cell damage, along with fatty build-up in the liver. NASH can progress to scarring of the liver and ultimately to cirrhosis, with all the complications of cirrhosis (e.g., gastrointestinal bleeding, mental changes, liver failure, and liver cancer).

Can we treat NAFLD and NASH?

One of the first things that doctors currently recommend for improving the symptoms and outcomes in NAFLD is to lose weight, as this can reduce fat in the liver, inflammation, and fibrosis. Doctors recommend gradually losing 7 percent (or more) of your body weight over the course of a year or more. This gradual loss is important since rapid weight loss through very low calorie diets or fasting (eating and drinking nothing but water) can actually make NAFLD worse.

In addition, a very large, long-term study recently wrapped up that further demonstrates the importance of body weight. NAFLD patients who lost any amount of weight during the six years of this study had the lowest risk of disease progression, with this health protection increasing with the more weight that was lost. Conversely, any weight gain contributed to disease progression. This new research adds support to the idea that holding the line on weight is important, while losing weight (in those who are overweight) is even more valuable for long-term health of NAFLD patients.

No medications have yet been approved to treat NAFLD and NASH; however, there are many therapies in the pipelines that could soon improve the outlook for these patients. Currently, there are varying degrees of success with off-label medications, endoscopic interventions, and bariatric surgery. But researchers are working hard to find other, more reliable treatment options.

There are an estimated 800 clinical trials of potential disease therapies in the works, including trials of the medications cenicriviroc from Allergan, selonsertib from Gilead Sciences, obeticholic acid from Intercept, elafibranor from Genfit, and Emricasan from Conatus Pharmaceuticals. There is hope that within the next couple of years we will have one (or more) FDA-approved treatment options for NAFLD and NASH.


Kim Y, Change Y, Cho YK, et al. Obesity and weight gain are associated with progression of fibrosis in patients with non-alcoholic fatty liver disease. Clin Gastro Hep 2018 DOI: https://doi.org/10.1016/j.cgh.2018.07.006