Hormonal
In patients with Non-Alcoholic Steatohepatitis (NASH), elevated fecal primary bile acids (cholic acid and chenodeoxycholic acid) and increased hepatic bile acid synthesis correlate with markers of hepatic injury (steatosis, fibrosis, and elevated liver enzymes).
If you have NASH, your liver is producing and excreting higher levels of bile acids, which are directly linked to liver damage. This isn't just about 'fatty liver' from eating too much; it's a specific metabolic signaling issue. Managing this likely requires addressing the underlying metabolic dysregulation rather than just weight loss alone, as bile acid profiles are a key marker of disease severity.
Fecal levels of unconjugated primary bile acids positively correlated with steatosis, ballooning, fibrosis and NAFLD activity score (NAS)... Unconjugated primary bile acids also correlated with serum markers of liver injury AST, ALT, as well as triglyceride levels.
Why this rating
Prospective, cross-sectional study with biopsy-confirmed diagnoses, though sample size is moderate (n=53).
Source
Bile Acids and Dysbiosis in Non-Alcoholic Fatty Liver Disease
Marialena Mouzaki et al. · PLoS ONE · 2016
DOI 10.1371/journal.pone.0151829
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