NASH Diagnosis

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MEDICAL HISTORY

As part of the medical history, your doctor will ask:

• • What medicines you take to determine whether a medicine might be causing your fatty liver.
  • About your alcohol use, to determine whether the fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver disease. Medical tests cannot show whether alcohol is the cause of fat in the liver, so it’s important to be honest with your physician.
  • What your diet is like, your level of physical activity, and other lifestyle factors that can contribute to the likelihood of developing NAFLD
  • If you have a history of other health conditions that make you more likely to develop NAFLD, such as type 2 diabetes, obesity, high blood pressure and high levels of fats such as triglycerides or abnormal cholesterol levels.

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PHYSICAL EXAM

During the physical exam, you doctor will:

• • Examine your body looking for signs of NAFLD or NASH such as an enlarged liver or yellowing of your skin and whites of your eyes (jaundice).
  • Check your height and weight to calculate your body mass index (BMI). Your BMI estimates how much you should weigh based on your height. Refer to the chart below to see what category your BMI falls into. Most experts say that a BMI greater than 30 (obesity) is unhealthy. If you want to figure out your BMI on your own, there are many websites that calculate it for you when you enter your height and weight.

If you have more or less muscle than is normal, your BMI may not be a perfect measure of how much body fat you have. Your healthcare provider may also take your waist circumference and waist-to-hip ratio into consideration.

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BLOOD TESTS

The following blood tests will be included as part of your medical evaluation.

• Liver function tests (LFTs) or liver enzymes
  These are a group of blood tests that are used to detect, evaluate, and monitor liver disease and damage.

The cells in your liver contain proteins called enzymes, which are chemicals that help the liver do its work. When liver cells are damaged or destroyed, the enzymes in the cells leak out into the blood where they can be measured by blood tests. Liver enzyme testing usually checks the blood for two main enzymes:

• ALT (alanine aminotransferase)
• AST (aspartate aminotransferase)

If your liver is damaged due to inflammation, the level of these enzymes may be higher than normal. However, ALT and AST levels do not tell you how much scarring (fibrosis) may be present in your liver or predict how much liver damage will develop. In some people with NAFLD these liver enzymes may be normal as well

• Fibrosis assessment tests
  These blood tests result in a score that estimates your level of liver scarring or fibrosis. They include:
  • AST-to-Platelet Ratio Index (APRI) score
  • Fibrosis-4 (Fib-4) score

• Lipid profile
  This test measures blood fats, such as cholesterol and triglycerides.

It’s likely other blood tests will be done to rule out co-existing causes for fatty liver, including:

• Tests for chronic viral hepatitis, like hepatitis C
• Testing for other less common causes of fat in the liver including rare genetic conditions like Wilson Disease
• Hemoglobin A1C, which shows how stable your blood sugar is

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IMAGING TESTS

Your doctor may order tests that take images, or pictures, of your liver to help make the diagnosis of liver disease. Different types of images can be obtained by using various types of equipment, including: