Fish Oil and Diet for the Treatment of Non-Alcoholic Steatohepatitis (NASH)

Inclusion Criteria: * Males and females at least 18 years of age. * Evidence of nonalcoholic steatohepatitis (NASH) on a liver biopsy performed within six months of entry to this study. * Laboratory parameters indicative of decompensated liver disease including: * bilirubin less than 2 milligrams/decilitre (mg/dl). * stable albumin within normal limits. * prothrombin time less than 3 seconds prolonged. * Serum creatinine less than 1.5 times the upper limit of normal. * Diabetic patients must be stable on oral medication for diabetes or have had less than a 10 percent change in their insulin dose over the past two months. * Thyroid stimulating hormone (TSH) or Free Thyroxine Index (FTI) within the normal range. * Hepatitis C antibody negative. * Hepatitis B Surface Antigen (HBsAg) seronegative. * Antinuclear antibody (ANA) less than 1:320. * Patient provides written informed consent. Exclusion Criteria: * Alcohol use exceeding 10 to 29 grams per day during the past six months. * Evidence of a cause of liver disease other than nonalcoholic steatohepatitis (NASH) on liver biopsy including: viral hepatitis, alcoholic liver disease, autoimmune hepatitis, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, or recent hepatoxic drug exposure. * Patients with cirrhosis. * Use of medications commonly associated with nonalcoholic steatohepatitis (NASH) including: glucocorticoids, estrogens, tamoxifen, methotrexate, nifedipine, diltiazem, chloroquine, isoniazid, or amiodarone within the past six months. * Use of non-steroidal antiinflammatory drugs, fibrates (fenofibrate or gemfibrozil) or warfarin within one month of entering the study. * Uncontrolled diabetes, defined as a glycated hemoglobin (A1C) level greater than 8%. * Patients with insulin-dependent diabetes. * History of jejunal-ileal bypass or extensive small bowel resection. * Substance abuse including, but not limited to, alcohol or intravenous and inhaled drugs within the past six months. * Use of chemotherapy within six months of enrollment. * Patients taking metformin. * Thyroid abnormality in which normal thyroid function cannot be maintained by medication. * Pregnancy, females who are breastfeeding. * Solid organ transplant recipient. * History of a medical condition, which could interfere with participation in and completion of the protocol. * Use of oral supplements of Vitamin E within one month of enrollment.