How a Middle-Aged Man Successfully Managed Non-Alcoholic Steatohepatitis (NASH) Through Diet and Medication
A 45-year-old male patient with no history of chronic alcohol consumption was diagnosed with elevated liver enzymes two years prior. He had undergone intermittent treatment, with fluctuating results. One month before his most recent checkup, his liver function tests showed a further increase in transaminase levels. Hepatitis B surface antibody was positive, and hepatitis C antibody was negative. An abdominal ultrasound revealed fatty liver, prompting a visit to the hospital where he was diagnosed with non-alcoholic steatohepatitis (NASH). After implementing dietary changes and undergoing targeted medication therapy, his condition was successfully controlled.
Key Details:
- Age: 45
- Gender: Male
- Diagnosis: Non-Alcoholic Steatohepatitis (NASH)
- Hospital: The 988 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army
- Treatment Period: 17 days of inpatient care followed by 2 months of outpatient follow-up
- Treatment Approach: Intravenous magnesium isoglycyrrhizinate, oral reduced glutathione tablets, silymarin capsules, combined with lifestyle modifications
- Outcome: Normalized liver function after treatment
Initial Consultation and Diagnosis
The patient visited the clinic complaining of intermittent elevated transaminase levels over the past two years. Hepatitis B and C tests were negative, lipid levels were within normal range, and he had no significant alcohol consumption history. An ultrasound confirmed fatty liver, but liver enzymes remained abnormal. Upon further inquiry, it was revealed that the patient had consistently high blood sugar levels, often fluctuating around 8 mmol/L. His sedentary lifestyle and preference for high-fructose, greasy foods and beverages contributed to his condition. Given the presence of obesity and prediabetic symptoms, a diagnosis of NASH was made.
Course of Treatment
Due to persistent liver function abnormalities affecting his daily life, the patient was admitted for comprehensive testing. Blood work revealed total bilirubin at 15.9 μmol/L, ALT at 282 U/L, and AST at 117 U/L. Fasting blood glucose was 7.83 mmol/L. A liver biopsy confirmed NASH. He was treated with magnesium isoglycyrrhizinate injections, reduced glutathione tablets, and silymarin capsules to reduce liver inflammation and oxidative stress. In addition, he was advised on lifestyle changes including increased physical activity and a healthier diet.
Positive Outcomes After Treatment
After 17 days of treatment—including dietary modifications, physical activity, and medication—his liver function tests returned to normal. Post-biopsy recovery also helped alleviate his anxiety. Follow-up tests showed total bilirubin at 13.2 μmol/L, ALT at 26 U/L, and AST at 19 U/L. His fasting blood glucose improved to 6.49 mmol/L. He was scheduled for outpatient follow-up after two months.
Post-Treatment Recommendations
It is crucial for patients with NASH to continue liver-protective therapy after discharge. Weight management should be gradual to avoid rapid weight loss that may worsen liver damage. Regular monitoring of liver enzymes, lipids, blood sugar, and liver stiffness via non-invasive methods is highly recommended. Patients should also avoid hepatotoxic drugs and maintain a healthy lifestyle.
Insights on NASH Prevention and Management
NASH is closely linked to metabolic syndrome, including abdominal obesity, diabetes, and a sedentary lifestyle. More than 60% of patients can reverse liver damage through weight loss and dietary improvements. If lifestyle changes alone are insufficient within 3–6 months, adding medications to control blood sugar, cholesterol, and liver inflammation can yield positive outcomes. This case highlights the importance of early diagnosis and a multidisciplinary approach to managing NASH effectively.