What is the treatment for Non-Alcoholic Fatty Liver Disease (NAFLD)?

From the Guidelines

Lifestyle modification using diet and exercise to achieve weight loss is the primary treatment approach for nonalcoholic fatty liver disease (NAFLD), with a goal of losing 7-10% of body weight. This approach is supported by the most recent and highest quality study 1, which provides best practice advice statements for the management of NAFLD. The key components of this approach include:

• A hypocaloric diet targeting 1200–1500 kcal/d or a reduction of 500–1000 kcal/d from baseline 1
• A Mediterranean diet rich in fruits, vegetables, whole grains, olive oil, and lean proteins, with minimal saturated fatty acid intake and limited or eliminated consumption of commercially produced fructose 1
• Regular physical activity, with a target of 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week, and consideration of resistance training exercise as a complementary approach 1
• Management of coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, through aggressive treatment 1
• Restriction or elimination of alcohol consumption 1

It is essential to note that while medications like vitamin E, pioglitazone, or GLP-1 receptor agonists may provide secondary benefits for fatty liver, lifestyle modification remains the primary treatment approach, and medications should only be considered in specific cases, such as non-diabetic patients with more advanced disease (NASH) 1. Regular monitoring with a healthcare provider is crucial to prevent progression to more serious liver conditions.

From the Research

Treatment Options for Non-Alcoholic Fatty Liver Disease

• Lifestyle modifications such as weight loss, a Mediterranean diet, and physical activity are considered first-line treatments for non-alcoholic fatty liver disease (NAFLD) 2, 3
• Pharmacological treatment options include Vitamin E and Pioglitazone, which are recommended by current international guidelines for non-alcoholic steatohepatitis (NASH) 2, 4
• Other drugs such as metformin, polyunsaturated fatty acids, and statins have shown benefits in improving metabolic parameters and reducing hepatic lipid accumulation and inflammation, but their role in specifically reversing NASH needs to be established 4, 5
• Novel drugs targeting hepatic fat accumulation, oxidative stress, inflammation, and apoptosis, as well as intestinal microbiomes and metabolic endotoxemia, are being evaluated in clinical trials 6

Emerging Therapies

• GLP-1 agonists, FXR and PPAR ligands, and other agents have shown promising results in experimental models of NAFLD or NASH lesions and are being evaluated in humans 2, 6
• Antifibrotic agents such as cenicriviroc and galectin 3 antagonist are being developed to target hepatic fibrosis, which is strongly associated with all-cause or liver-related mortality in NASH 6
• Several agents, including obeticholic acid, elafibranor, ASK1 inhibitor, and CVC, are currently being evaluated in international phase 3 trials for the treatment of NASH 6

Management of Complications

• Knowledge about treating complications of end-stage liver disease due to NASH is becoming increasingly important in the treatment of the broad disease spectrum of NAFLD 2
• Statins have been shown to reduce the risk of cardiovascular morbidity and mortality in patients with NASH and dyslipidemia, but their use specifically for treatment of NASH needs further evaluation 5