Nonalcoholic steatohepatitis (NASH) is a more severe type of nonalcoholic fatty liver disease (NAFLD) that can damage your liver. It can cause liver scarring and other potentially serious complications.

It’s important to follow your recommended treatment for NASH to prevent potential complications, such as:

  • fibrosis, which is scarring in your liver
  • cirrhosis, which is severe fibrosis
  • liver failure
  • liver cancer

Following your treatment may also lower your risk of other health conditions that are more common than average in people with NASH, including other types of cancer, cardiovascular disease, and type 2 diabetes.

Read on to find the answers to some common questions about complications of NASH.

Nonalcoholic steatohepatitis (NASH) is now known as metabolic dysfunction-associated steatohepatitis (MASH). This new name is more accurate and helps reduce the stigma associated with its older name.

According to the American Association for the Study of Liver Diseases (AASLD), the name change took effect in June 2023 and was agreed upon by a group of multinational liver societies and organizations.

MASH can cause complications that affect your liver and may also raise your risk of health conditions that affect other parts of your body. These potential complications and conditions are as follows.

Fibrosis and cirrhosis

Fibrosis is scarring that can develop from inflammation and liver damage. MASH may cause fibrosis, which can range from mild to severe.

The stages of fibrosis include:

  • Stage 0: no fibrosis
  • Stage 1: mild fibrosis
  • Stage 2: moderate fibrosis
  • Stage 3: advanced fibrosis or a lot of scarring
  • Stage 4: cirrhosis, which is the most severe form of fibrosis

Cirrhosis happens when severe scarring replaces healthy liver tissue and makes it hard for your liver to work properly. It raises your risk of life threatening liver failure and liver cancer.

About 5% to 20% of people with MASH may develop cirrhosis. These estimates are based on a combination of older resources. More current research on the topic is necessary.

Following your recommended treatment may help reverse scarring in your liver, especially in the early stages of fibrosis. It’s rare to reverse cirrhosis.

Liver failure

Cirrhosis from MASH can potentially cause liver failure, which happens when your liver loses its ability to work properly.

Liver failure may develop gradually over multiple months or years.

It’s a life threatening condition that may require a liver transplant to treat.

Cancer

MASH can potentially cause hepatocellular carcinoma (liver cancer), which is a type of cancer that begins in liver cells. It may spread from your liver to other parts of your body.

You have an increased risk of liver cancer if you develop cirrhosis. Depending on the cause and stage of cirrhosis, as well as a person’s age and sex, the chances of developing liver cancer at 5 years after diagnosis is about 5% to 30%.

A 2022 research review found that MASH may also raise your risk of cancers that begin outside your liver, including:

  • gastrointestinal cancers, such as:
    • esophageal cancer
    • stomach cancer
    • pancreatic cancer
    • colorectal cancer
  • urinary system cancers, such as:
    • bladder cancer
    • kidney cancer
  • gynecological cancers, such as:
    • uterine cancer
    • ovarian cancer
  • breast cancer
  • lung cancer
  • thyroid cancer

Cardiovascular disease

A 2022 research review found that MASH and other forms of NAFLD raise your risk of certain conditions that negatively affect your heart and blood vessels, including:

  • hypertension (high blood pressure)
  • atherosclerosis, which is a buildup of plaque in your arteries
  • cardiovascular disease, including:
    • coronary artery disease
    • heart failure
    • myocardial infarction (heart attack)
    • arrhythmia (irregular heart rhythms)

MASH and cardiovascular disease share some common risk factors, including obesity.

MASH also causes inflammation and other changes that may negatively affect your blood vessels and heart, which helps explain the link between MASH and cardiovascular disease.

Type 2 diabetes

MASH and other forms of NAFLD raise your risk of type 2 diabetes, which is a chronic condition that develops when cells in your body become resistant to the hormone insulin.

MASH and type 2 diabetes share some common risk factors, including obesity.

MASH may also worsen insulin resistance and cause other changes in your body that may help explain the link with type 2 diabetes.

Type 2 diabetes increases your risk of cardiovascular disease and may also cause other serious complications.

MASH may worsen over time if you don’t take steps to treat it.

This raises your risk of liver complications, such as cirrhosis, liver failure, and liver cancer.

It also raises your risk of other health conditions that are more common in people with MASH, including some other types of cancer, cardiovascular disease, and type 2 diabetes.

Some of the potential complications of MASH are life threatening.

The most common causes of death in people with MASH include:

  • cardiovascular disease
  • cancer
  • cirrhosis

Treatment for MASH can help lower your risk of serious complications.

Attending regular checkups with your doctor and following their treatment recommendations is important for preventing complications from MASH.

Treatment for MASH typically includes weight loss and healthy lifestyle habits.

Your doctor might also prescribe medication or other treatments.

Regular checkups

Attending regular checkups with your doctor is important for managing your risk of complications from MASH.

During checkups, your doctor will:

  • conduct a physical exam
  • ask about your lifestyle habits
  • ask about any changes in your health

They may order certain medical tests, such as:

  • blood tests to measure your liver enzymes, blood sugar, or other health markers
  • imaging tests to check your liver or other organs for signs of damage
  • liver biopsy to collect a sample of liver tissue to examine

These tests help them check for changes in your liver health or risk of complications from MASH.

Let your doctor know about any changes in your health or any questions or concerns you have about your treatment.

Weight loss

Your doctor will likely advise you to lose weight to help treat MASH and reduce your risk of complications, including cardiovascular disease and type 2 diabetes.

Weight loss typically involves eating fewer calories and exercising more often.

Your doctor might also prescribe medication or surgery to support weight loss.

Consider asking your doctor for a referral to a weight loss specialist or registered dietitian who can help support your goals.

Healthy lifestyle habits

You may be able to help treat MASH or lower your risk of complications, such as cardiovascular disease and type 2 diabetes, by:

  • Balancing your calorie intake with your physical activity level to maintain a moderate weight.
  • Limiting trans fats, saturated fats, and sweetened foods and beverages.
  • Eating a variety of nutrient-rich foods.
  • Limiting or avoiding alcohol.
  • Avoiding tobacco.
  • Getting regular exercise.
  • Getting enough sleep.
  • Taking steps to manage stress.

If you’re having difficulty making lifestyle changes, let your doctor know. They may refer you to a specialist who can help you make changes and develop healthy habits.

Medication

Your doctor may prescribe the medication resmetirom (Rezdiffra) if you have MASH with moderate to advanced liver fibrosis. This medication may help reduce liver scarring.

Rezdiffra is not safe for people with advanced cirrhosis or liver failure.

Your doctor may also prescribe medication to help:

  • manage your blood sugar levels
  • lower your blood pressure, cholesterol, or triglyceride levels
  • reduce your risk of blood clots
  • support weight loss

Your prescribed medication will depend on your specific condition and risk factors for complications.

It’s important to tell your doctor about any medications or supplements you’re currently taking and talk with them before starting a new medication or supplement.

Certain medications or supplements may not be safe for people with MASH.

Certain medications or supplements may interact with others and raise your risk of side effects.

Attending regular checkups with your doctor and following their recommended treatment is important for managing complications from MASH.

Your treatment plan will depend on the specific complications you develop.

It may include:

  • weight loss strategies
  • lifestyle changes
  • medication
  • other treatments

Weight loss and healthy lifestyle habits can help treat MASH and many potential complications, including cardiovascular disease and type 2 diabetes.

Medication may be necessary if weight loss and healthy habits are not enough to manage complications.

Liver failure may require a liver transplant to treat.

Cancer treatment options depend on the specific type of cancer and how early doctors diagnose it.

Your outlook with MASH depends on multiple factors, including:

  • your weight and overall health
  • how closely you follow your treatment
  • whether you develop any complications

It may be possible to reverse MASH by following your recommended treatment. MASH is more difficult to reverse after severe scarring develops, but treatment can still help.

Talk with your doctor to learn more about your condition and how to improve your outlook.

MASH can cause liver scarring, which raises your risk of liver failure and liver cancer.

MASH also increases the risk of other conditions, including:

  • some other types of cancer
  • cardiovascular disease
  • type 2 diabetes

Maintaining a moderate weight and following healthy lifestyle habits is important to help prevent and manage potential complications. A doctor may also prescribe medication or other treatments and help you learn more about your options and outlook.