Fibrosis and Cirrhosis
The inflammation and liver cell damage that happen with NASH can cause serious problems. The inflamed liver will start to scar, a process called fibrosis (scar tissue is a kind of fibrous tissue). If left untreated, scar tissue will continue to replace healthy liver tissue leading to cirrhosis, which is advanced, late-stage scarring. About 20% of people with NASH will progress to cirrhosis over several years typically decades. Once you’ve been diagnosed with cirrhosis, treatment will focus on keeping your condition from getting worse. It may be possible to stop or slow the liver damage. Doctors can treat the health problems caused by cirrhosis with medications, operations, and other medical procedures. It’s important to protect the healthy liver tissue you have left.
If cirrhosis is not treated, the liver will not be able to work well or work at all. Liver failure means that your liver is losing or has lost all of its function. When liver failure occurs as a result of cirrhosis, it usually means that your liver has been failing gradually for some time, possibly for years. If cirrhosis leads to liver failure, you may need a liver transplant.
One of the complications of cirrhosis is liver cancer. Liver cancer is the growth and spread of unhealthy cells in the liver. Cancer that starts in the liver is called primary liver cancer or hepatocellular carcinoma (HCC). Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. NAFLD is now considered the third-most common cause of HCC in the United States behind hepatitis C and alcohol induced liver disease although it is increasing more rapidly than from other conditions. You can read more about the general progression of liver disease here.
Cardiovascular Disease/Type 2 Diabetes
The association between NAFLD and NASH with both cardiovascular disease and type 2 diabetes is bidirectional. This means that people with cardiovascular disease and/or type 2 diabetes are more likely to have NAFLD and NASH. And conversely, people with NAFLD or NASH are more likely to have cardiovascular disease and/or type 2 diabetes. In fact, cardiovascular disease is the most common cause of death in people who have either form of NAFLD.