From the Guidelines
The primary treatment for fatty liver disease involves lifestyle modifications, particularly weight loss through diet and exercise, as recommended by the most recent guidelines 1.
Key Recommendations
- Aim to lose 5-10% of body weight gradually by following a Mediterranean-style diet (rich in fruits, vegetables, whole grains, lean proteins, and healthy fats) and reducing intake of processed foods, sugar, and alcohol 1.
- Regular exercise of at least 150 minutes per week of moderate-intensity activity is recommended 1.
- For those with nonalcoholic steatohepatitis (NASH), management of associated conditions like diabetes, high cholesterol, and hypertension is also important 1.
- Bariatric surgery is also an option in individuals with MASLD and obesity 1.
- If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage >2) should be considered for a MASH-targeted treatment with resmetirom 1.
Lifestyle Modifications
- Diet: Mediterranean-style diet, minimizing saturated fatty acid intake, and limiting or eliminating consumption of commercially produced fructose 1.
- Exercise: Regular physical activity, with a target of 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week 1.
- Weight loss: Aim for a modest weight loss of 3–5% in lean persons with NAFLD, and 5-10% in overweight or obese individuals 1.
Management of Associated Conditions
- Diabetes: Management with medications such as metformin, and consideration of incretin-based therapies (e.g. semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated 1.
- High cholesterol and hypertension: Optimal management to reduce cardiovascular risk 1.
From the Research
Treatment Options for Fatty Liver
- Lifestyle modifications, including weight loss, dietary changes, and increased physical activity, are considered the primary therapy for managing non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5
- A Mediterranean diet, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake, is recommended for NAFLD patients 2
- Weight loss of ≥10% can induce a near-universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage, while modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS) 2
- Physical activity, including aerobic activity and resistance training, has therapeutic effects on NAFLD by reducing hepatic fat independent of weight reduction 5
Pharmacological Treatment Options
- Currently, only a few NAFLD-specific pharmacological treatment options, such as Vitamin E and Pioglitazone, are considered by international guidelines 6
- Recent randomized controlled trials with GLP-1 agonists, FXR, and PPAR ligands, as well as other agents, may expand the therapeutic armamentarium for NAFLD in the near future 6
Importance of Lifestyle Modifications
- Lifestyle modifications, including weight loss, dietary changes, and increased physical activity, are essential for managing NAFLD and preventing its progression to non-alcoholic steatohepatitis (NASH) with advanced fibrosis 2, 3, 4, 5
- Physical activity can prevent the development of NAFLD and may represent a valuable strategy for reducing the public health burden 5