From the Guidelines
Lifestyle modification using diet and exercise to achieve weight loss is the primary treatment for nonalcoholic fatty liver disease (NAFLD), with a goal of losing 5-10% of total body weight to decrease hepatic steatosis and improve histologic outcomes. The treatment approach should be multifaceted, incorporating dietary changes, increased physical activity, and management of coexisting metabolic conditions. According to the American Gastroenterological Association's clinical practice update 1, the Mediterranean diet is recommended, with an emphasis on minimizing saturated fatty acid intake and limiting consumption of commercially produced fructose. A hypocaloric diet targeting 1200-1500 kcal/d or a reduction of 500-1000 kcal/d from baseline can help achieve clinically significant weight loss. Regular physical activity, aiming for 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week, is also crucial in managing NAFLD. Additionally, patients with NAFLD should be evaluated for coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, and these comorbidities should be managed aggressively 1. It is also essential to restrict or eliminate alcohol consumption from the diets of adults with NAFLD. By prioritizing lifestyle modifications and managing underlying conditions, patients with NAFLD can reduce their risk of disease progression and improve their overall quality of life. Key considerations in the treatment of NAFLD include:
- Weight loss goals of 5-10% of total body weight
- Adoption of the Mediterranean diet
- Regular physical activity
- Management of coexisting metabolic conditions
- Restriction or elimination of alcohol consumption.
From the Research
Treatment Options for Fatty Liver
- Lifestyle modifications, including weight loss, increased physical activity, and dietary changes, are considered the primary treatment for non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5, 6
- Weight loss has been shown to ameliorate biochemical, histological, and structural abnormalities of NAFLD 2, 6
- Increased physical activity, including aerobic and resistance training, has therapeutic effects on NAFLD by reducing hepatic fat independent of weight reduction 3, 4
- Dietary modifications, such as reducing saturated fat and carbohydrate intake, and increasing consumption of certain foods or drinks, may also be beneficial in the treatment of NAFLD 4, 5
Lifestyle Interventions
- A holistic, multidisciplinary, and individualized approach to disease management is recommended for achieving realistic population-level change 5
- Physical activity should be tailored based on a patient's clinical characteristics, comorbidities, and fitness capacity 3
- Lifestyle interventions, including dietary modifications and weight loss, have been shown to have promising results in the treatment of NAFLD, but can be difficult to maintain 6
Diagnosis and Treatment
- Histologic evaluation with liver biopsy remains the gold standard to diagnose NAFLD 6
- Diagnosis of NAFLD is defined as presence of hepatic steatosis, ballooning and lobular inflammation with or without fibrosis 6
- Treatment of underlying metabolic syndrome, including diabetes and obesity, is also an important aspect of NAFLD management 6