My husband was recently diagnosed with NASH. My question: Should he also be tested for diabetes? He is overweight, his mother was a diabetic and he has symptoms: thirst and not healing. But the doctor says his fasting blood sugar is good and there is no need for further testing. Should I insist? Also, does taking care of diabetes help NASH?

K.W.

NASH (non-alcoholic steatohepatitis) is a term for a liver that contains fatty deposits and shows evidence of inflammation, but has not been damaged by alcohol. Since the most common reason for fatty deposits in the liver is alcohol abuse, this must be ruled out before making the diagnosis of NASH.

Patients are generally diagnosed with NASH when blood tests are done for an unrelated reason. These tests will show elevated levels of liver-specific enzymes in the blood. Many diseases and many medications can elevate liver enzymes, so a thorough evaluation will usually be done to rule these out. Eventually, if the enzymes stay elevated for a prolonged period of time (usually several months), a liver biopsy is done to confirm the diagnosis.

Obesity is a risk factor for NASH, and it has been shown that weight loss can sometimes reduce the liver abnormalities as well as reduce elevated enzyme levels. NASH is also associated with diabetes and with high lipid levels. To answer your question, any patient with NASH should be evaluated for diabetes. Treatment of diabetes can often reverse the abnormalities seen in NASH.

Many patients with NASH have elevated liver enzyme levels without experiencing any serious liver problems. However, there have been cases of NASH that have progressed to liver scarring and ultimately to life-threatening cirrhosis. Thus, is it crucial to find potentially treatable factors early. Close follow-up with a gastroenterologist experienced in treating NASH is important.