From the Guidelines
Treating fatty liver primarily involves lifestyle modifications, with a focus on weight loss, dietary changes, and regular exercise, as recommended by the most recent guidelines 1.
Key Recommendations
- Lifestyle modification is the cornerstone of treatment, aiming for a gradual 5-10% reduction in body weight through a balanced diet and regular exercise 1.
- Limit alcohol consumption completely or significantly, as alcohol worsens liver damage.
- Follow a Mediterranean-style diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats while avoiding processed foods, sugary beverages, and high-fructose corn syrup.
- Exercise regularly with at least 150 minutes of moderate activity weekly.
- Control diabetes and high cholesterol if present, as these conditions can worsen fatty liver.
Medications and Other Interventions
- Currently, no medications are specifically FDA-approved for fatty liver treatment, though vitamin E (800 IU daily) may help in non-diabetic patients with confirmed NASH 1.
- Pioglitazone and GLP-1 RAs, such as semaglutide, may be beneficial in improving glucose and lipid metabolism, reversing steatohepatitis, and improving fibrosis in people with type 2 diabetes and NASH 1.
- Bariatric surgery may be an option in individuals with fatty liver disease and obesity 1.
Monitoring and Follow-up
- Regular follow-up with healthcare providers is essential to monitor liver function and adjust treatment as needed.
- Non-invasive tests, such as blood-based scores and imaging techniques, can be used to rule out advanced fibrosis and monitor disease progression 1.
From the Research
Treatment Options for Fatty Liver
- Lifestyle intervention is an effective treatment for non-alcoholic fatty liver disease (NAFLD) patients, as it can decrease cardiovascular and diabetes risk and regress liver disease 2.
- Weight loss is a crucial aspect of treating NAFLD, with weight reductions of ≥10% inducing a near-universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage 2, 3.
- Modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS) 2.
- The Mediterranean diet is recommended for NAFLD patients, as it can reduce liver fat even without weight loss, and is characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake 2.
Dietary Modifications
- The habitual diet plays a relevant role in the pathogenesis of NAFLD, with risky foods (e.g., fructose) and protective foods (e.g., Mediterranean diet) described 3.
- Excess calories remain a pivotal contributor to fatty liver accumulation, and weight loss is the most effective way to promote liver fat removal 3.
- A holistic, multidisciplinary, and individualized approach to disease management is key to achieving population-level change in NAFLD treatment 4.
Pharmacological Treatments
- There are no approved pharmacological treatments for NASH/NAFLD, but several clinical trials have been undertaken to evaluate the efficacy of various agents 5.
- Pioglitazone is the only agent that has shown consistent benefit and efficacy in clinical trials, while other agents such as pentoxifylline, rosiglitazone, and ursodeoxycholic acid have had mixed results 5.
- Vitamin E and metformin have also shown evidence of efficacy in treating NAFLD/NASH 5, 6.
Management and Prevention
- Lifestyle modification is the foundation of treatment for patients with non-alcoholic steatosis, and early identification of patients with non-alcoholic steatohepatitis may help improve patient outcomes through treatment intervention 6.
- The association between non-alcoholic steatohepatitis and cardiovascular disease is clear, and the incidence of non-alcoholic fatty liver disease-related hepatocellular carcinoma is increasing 6.