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Steatohepatitis is a type of fatty liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver. Mere deposition of fat in the liver is termed steatosis, and together these constitute fatty liver changes.
The two main types of fatty liver disease (FLD) are:
Risk factors for MASLD include diabetes, obesity, and metabolic syndrome. When inflammation is present, it is referred to as alcoholic steatohepatitis and nonalcoholic (metabolic dysfunction associated) steatohepatitis (MASH, previously NASH). Steatohepatitis of either cause may progress to cirrhosis, and MASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies). MASH is also associated with lysosomal acid lipase deficiency.
The word is from "steato-", meaning fat, "hepatitis", meaning liver, and "itis", meaning inflammation, hence "inflammation of the liver".
Treatment for MASH and MASLD is primarily with healthy diet, exercise, and weight loss, which have been shown to cause regression of liver cell damage in MASH. General recommendations include improving metabolic risk factors and reducing alcohol intake. A weight loss of 5-10% has been found to lead to regression of liver cell damage on biopsy in MASH, with a weight loss greater than 10% being associated with 90% of people having resolution of disease. Bariatric surgery is sometimes used. As of March 2024, there is one medication, resmetirom (Rezdiffra™) commercially available in the US for management of NASH. NASH was first described in 1980 in a series of patients of the Mayo Clinic. Its relevance and high prevalence were recognized mainly in the 1990s. Some think NASH is a diagnosis of exclusion, and many cases may, in fact, be due to other causes.
MASH is expected to be the leading indication for liver transplantation in the United States, surpassing ALD.
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