From the Guidelines
Management of fatty liver disease primarily involves lifestyle modifications, with a focus on weight loss of 7-10% through a balanced diet and regular exercise, as recommended by the most recent guidelines 1. The cornerstone of treatment for fatty liver disease is lifestyle modification, which includes a balanced diet and regular exercise.
- Weight loss of 7-10% is recommended, as it reduces fat accumulation in the liver and improves insulin sensitivity.
- Patients should limit alcohol consumption completely or significantly, avoid processed foods and sugary beverages, and follow a Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats.
- Regular physical activity of at least 150 minutes per week of moderate-intensity exercise is recommended, as it complements the effects of a hypocaloric diet on liver health 1.
- For diabetic patients with fatty liver, medications like pioglitazone or GLP-1 receptor agonists may provide additional benefits, as they have been shown to improve insulin sensitivity and reduce liver fat accumulation.
- Vitamin E may be considered for non-diabetic patients with biopsy-proven non-alcoholic steatohepatitis, as it has antioxidant properties that may help reduce liver inflammation.
- Regular monitoring of liver enzymes every 3-6 months and periodic imaging are important to track disease progression and adjust treatment as needed.
The most recent guidelines from the EASL-EASD-EASO 1 emphasize the importance of lifestyle modification and optimal management of comorbidities, such as type 2 diabetes and obesity, in the management of fatty liver disease.
- Bariatric surgery is also an option in individuals with fatty liver disease and obesity, as it can lead to significant weight loss and improvement in liver health.
- Newer therapies, such as resmetirom, have shown promise in reducing liver fat accumulation and improving liver function in patients with non-cirrhotic fatty liver disease, but more research is needed to fully understand their efficacy and safety.
From the Research
Fatty Liver Disease Management
- Fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD), can be managed through lifestyle modifications, including diet, physical activity, and exercise 2, 3, 4.
- Weight loss is a crucial aspect of NAFLD management, with reductions of ≥10% inducing near-universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage 2.
- Modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS) 2.
- The Mediterranean diet is recommended for NAFLD patients, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake 2.
- Physical activity has therapeutic effects on NAFLD, reducing hepatic fat independent of weight reduction, with aerobic activity and resistance training having similar effects 3.
- Increased physical activity can prevent the development of NAFLD and reduce the public health burden 3.
Treatment Options
- Lifestyle modifications, including weight loss, diet, and physical activity, remain the primary therapy for NAFLD management 2, 3, 5, 4.
- Anti-obesity medications and bariatric endoscopic and surgical interventions may be considered when lifestyle changes are not successful 5.
- Certain drugs, such as pioglitazone, pentoxifylline, and vitamin E, have shown efficacy in clinical trials for NAFLD/NASH treatment 6.
- However, there are no approved pharmacological treatments for NASH/NAFLD, and more research is needed to identify effective therapeutics 6.
Importance of Lifestyle Modifications
- Lifestyle modifications can improve liver steatosis and fibrosis, reduce cardiovascular risk, and prevent the development of NAFLD 2, 3, 5, 4.
- A holistic, multidisciplinary, and individualized approach to disease management is essential for achieving realistic population-level change 4.
- Strategies to avoid relapse and weight regain should be implemented to maintain long-term lifestyle modifications 2.