From the Guidelines
Non-alcoholic steatohepatitis (NASH) treatment should focus on lifestyle modifications, including weight loss of 7-10% through a Mediterranean or low-carbohydrate diet and regular exercise, as this approach has been shown to improve liver histology and reduce the risk of progression to cirrhosis and liver failure 1.
Key Recommendations
- Weight loss of 7-10% is recommended for patients with NASH, as it has been shown to improve hepatic steatosis and reduce hepatic inflammation 1
- A Mediterranean or low-carbohydrate diet is recommended, as it has been associated with improved liver outcomes in patients with NASH 1
- Regular exercise, such as 150 minutes of moderate activity per week, is recommended to improve insulin sensitivity and reduce liver inflammation 1
- Vitamin E (800 IU daily) may be beneficial for non-diabetic patients with biopsy-proven NASH, as it has been shown to improve liver histology 1
- Medications like pioglitazone (15-45 mg daily) may be beneficial for diabetic patients with NASH, as they have been shown to improve liver histology and reduce liver inflammation 1
Important Considerations
- Patients with NASH should avoid alcohol completely, as it can exacerbate liver damage and increase the risk of progression to cirrhosis and liver failure 1
- Comorbidities like diabetes and hyperlipidemia should be managed aggressively, as they can contribute to the progression of NASH 1
- Regular monitoring with liver function tests and imaging is recommended to assess the progression of NASH and the effectiveness of treatment 1
- For advanced cases with cirrhosis, liver transplantation may be necessary, and patients should be referred to a liver transplant center for evaluation 1
From the Research
Definition and Treatment of NASH
- Nonalcoholic steatohepatitis (NASH) is a form of nonalcoholic fatty liver disease (NAFLD) that can progress to advanced liver disease 2.
- The current first-line treatment for NASH consists of lifestyle modifications, including a combination of physical exercise and calorie restriction dieting, with a goal of losing at least 7% to 10% of body weight 2.
Lifestyle Modifications
- 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, and physical activity should be tailored based on a patient's clinical characteristics, comorbidities, and fitness capacity 3.
- Weight loss through lifestyle modifications significantly reduces features of NASH, with a greater extent of weight loss associated with a higher level of improvement in histologic features of NASH 4.
Pharmacological Approaches
- There is no currently approved pharmacotherapy for NASH, but pioglitazone and vitamin E have the most evidence of therapeutic efficacy 2, 5.
- Statins, metformin, and polyunsaturated fatty acids may also have benefits in the treatment of NAFLD and NASH, but more research is needed to assess their long-term impact 5, 6.