What are the diagnostic clues for severe NASH?
The early identification of severe liver scarring, or cirrhosis, in NASH patients is of clinical importance because of the prognostic (outcome) information it conveys. This fact has led to several studies attempting to identify factors that predict severe liver scarring in patients with NASH and/or obesity. These studies found that patients at risk for severe scarring are most often age 50 or older, significantly obese (BMI greater than 30 kg/m2), and have DM2. Also, they often show an increase in liver enzymes (AST greater than ALT) despite the absence of alcohol use. As already mentioned, some iron deposits in the liver (iron overload) may be associated with NAFLD or NASH. This appears to be more common at the stage of severe, irreversible liver scarring (cirrhosis). Testing for serum iron markers, however, turns out to be of little use in predicting any degree of liver scarring (fibrosis). Moreover, the predictive role of genetic markers (HFE mutations) of hemochromatosis (hereditar
