From the Guidelines
Hepatic steatosis should be managed with lifestyle modifications, including weight loss, dietary changes, and physical exercise, as well as optimal management of comorbidities, such as type 2 diabetes and obesity, according to the most recent guidelines 1. The primary goal of treatment is to reduce liver fat and inflammation, and prevent progression to more severe liver disease.
- Lifestyle modifications, such as weight loss of 7-10% of body weight, can be achieved through a combination of calorie restriction and regular exercise, and are recommended as the first line of treatment 1.
- A Mediterranean diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats is also recommended, while limiting processed foods, added sugars, and saturated fats 1.
- Regular physical activity of at least 150 minutes per week of moderate-intensity exercise can help reduce liver fat and improve insulin sensitivity 1.
- For patients with diabetes, good glycemic control is essential, often requiring medications like metformin or pioglitazone, and incretin-based therapies, such as semaglutide or tirzepatide, may also be beneficial 1.
- Bariatric surgery is also an option in individuals with hepatic steatosis and obesity, and can lead to significant improvements in liver function and overall health 1.
- In adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and significant liver fibrosis, treatment with resmetirom may be considered, as it has demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1.
- Regular monitoring with liver function tests and imaging is important to track disease progression and adjust treatment as needed 1.
From the Research
Hepatic Steatosis Treatment
- Hepatic steatosis, also known as fatty liver disease, can be treated with various methods, including lifestyle modifications and medication 2.
- A study found that weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis, with a greater extent of weight loss associated with a higher level of improvement in histologic features of NASH 3.
- Vitamin E and pioglitazone have been shown to be effective in improving NASH histology, with vitamin E producing a significant decrease in steatosis and pioglitazone producing a significant decrease in steatosis, cytologic ballooning, Mallory's hyaline, and pericellular fibrosis 4, 5.
Pathogenesis and Prevention
- Hepatic steatosis is defined as intrahepatic fat of at least 5% of liver weight, and is associated with obesity, type 2 diabetes, and dyslipidemia 2.
- The accumulation of intrahepatic fat is due to several mechanisms, including increased flux of fatty acids to the liver, increased de novo lipogenesis, and/or reduced clearance through β-oxidation or very-low-density lipoprotein secretion 2.
- Lifestyle modifications, such as weight loss and exercise, can help prevent hepatic steatosis by reducing the accumulation of intrahepatic fat 3, 2.
Current Therapeutic Options
- Currently, there is no established treatment for nonalcoholic steatohepatitis, but various therapeutic options have been studied, including vitamin E, pioglitazone, and lifestyle modifications 6, 5.
- A systematic review with meta-analysis found that vitamin E was superior to placebo for the treatment of nonalcoholic steatohepatitis in adults without diabetes, while pioglitazone was not significantly better than placebo for the primary outcome 5.
- Other medications, such as orlistat, metformin, and thiazolidinediones, have been evaluated for the treatment of NASH, but have not been recommended as first-line treatment 6.