From the Guidelines
The primary treatment for fatty liver disease, also known as metabolic dysfunction-associated steatotic liver disease (MASLD), involves lifestyle modifications, including weight loss, dietary changes, physical exercise, and optimal management of comorbidities, as recommended by the most recent guidelines 1. The goal of treatment is to reduce liver fat, inflammation, and fibrosis, thereby preventing progression to more severe liver conditions like cirrhosis.
- Key lifestyle modifications include:
- Weight loss: aiming to lose 5-10% of body weight gradually through a balanced diet low in processed foods, sugars, and saturated fats, with a modest weight loss of 3-5% suggested for lean individuals with NAFLD 1.
- Dietary changes: following the Mediterranean diet, which emphasizes fruits, vegetables, whole grains, lean proteins, and healthy fats like olive oil, and limiting fructose and sugar-sweetened beverages 1.
- Physical exercise: regular physical activity of at least 150 minutes per week of moderate exercise to reduce liver fat and improve insulin sensitivity 1.
- Optimal management of comorbidities, such as type 2 diabetes, obesity, and hypertension, is also crucial, and may involve the use of incretin-based therapies, such as semaglutide or tirzepatide, if indicated 1.
- Additionally, bariatric surgery may be considered for individuals with MASLD and obesity, and resmetirom may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage >2) 1.
- It is essential to note that alcohol consumption should be completely avoided for alcoholic fatty liver disease and limited or avoided for non-alcoholic fatty liver disease, and managing underlying conditions like diabetes, high cholesterol, and hypertension is crucial to prevent worsening liver damage.
From the Research
Treatment Options for Fatty Liver
- Lifestyle modifications are considered the optimal intervention in combating non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5, 6
- Weight loss, via increased physical activity and dietary interventions, can potentially ameliorate biochemical, histological, and structural abnormalities of NAFLD 2, 4, 6
- Increased physical activity has therapeutic effects on NAFLD by reducing hepatic fat independent of weight reduction 3
- Aerobic activity and resistance training have similar effects on NAFLD 3, 4
- Dietary changes, including reduction of saturated fat and carbohydrates intake, can also play a role in the treatment of NAFLD 4, 6
Lifestyle Modifications
- Physical activity should be tailored based on a patient's clinical characteristics, comorbidities, and fitness capacity 3
- A therapeutic algorithm according to results from intervention trials can be provided for clinicians and other healthcare professionals involved in the management of NAFLD 4
- Lifestyle modification with diet, exercise, and weight loss is the cornerstone of therapy for NAFLD 5, 6
- A holistic, multidisciplinary, and individualized approach to disease management will be the key to achieving any realistic population-level change 6