From the Guidelines
The primary treatment for fatty liver disease involves lifestyle modifications, including weight loss through a balanced diet and regular exercise, with a goal of losing 3-5% of body weight to improve fat accumulation, and 7-10% weight loss to reduce inflammation. For non-alcoholic fatty liver disease (NAFLD), losing weight can improve liver histology, and regular physical activity can also enhance the positive effect of a hypocaloric diet 1. Currently, there are no FDA-approved medications specifically for fatty liver, but several medications may be prescribed based on individual circumstances.
- Vitamin E (800 IU daily) may help reduce inflammation in non-diabetic patients with non-alcoholic steatohepatitis (NASH) 1.
- Pioglitazone, a diabetes medication, can improve liver histology in patients with or without diabetes who have biopsy-proven NASH 1.
- GLP-1 receptor agonists like semaglutide and liraglutide have shown promise in reducing liver fat and inflammation 1.
- For those with diabetes, metformin may provide indirect benefits, although its effect on liver histology remains unknown 1.
- Statins are generally safe and may be beneficial for patients with dyslipidemia, and can be prescribed to patients with F2–F3 and Child A or B cirrhosis 1.
- For alcoholic fatty liver disease, complete abstinence from alcohol is essential. These medications work by reducing insulin resistance, oxidative stress, and inflammation in the liver, which are key factors in the progression of fatty liver disease. Regular monitoring of liver function tests is important while on these medications.
- A Mediterranean diet has the best evidence for improving liver and cardiometabolic health, and both aerobic and resistance training improve NAFLD in proportion to treatment engagement and intensity of the program 1.
- Obesity pharmacotherapy may assist with weight loss in the context of lifestyle modification if not achieved by lifestyle modification alone 1.
- Bariatric surgery performed by well-established programs is another tool that should be considered in appropriate individuals with clinically significant fibrosis and obesity with comorbidities 1.
From the FDA Drug Label
WARNINGS AND PRECAUTIONS Hepatic Decompensation and Failure in PBC Patients with Cirrhosis: Routinely monitor patients for progression of PBC, including hepatic adverse reactions, with laboratory and clinical assessments. The FDA drug label does not answer the question.
From the Research
Treatment for Fatty Liver
The treatment for fatty liver, also known as non-alcoholic fatty liver disease (NAFLD), typically involves lifestyle modifications, as there are no approved pharmacologic agents for its treatment 2, 3.
Lifestyle Modifications
- Weight loss: Losing 5-10% of body weight has been shown to improve histological outcomes in patients with NAFLD 3, 4
- Dietary changes: Reducing excessive caloric intake and high fructose consumption can help in managing NAFLD 3
- Increased physical activity: Aerobic activity and resistance training have similar effects on NAFLD, and even minimal physical activity can have a beneficial impact 2
Medications
While there are no approved FDA treatments for NAFLD, certain medications have been recommended in selected patients, including:
- Pioglitazone: May be considered in the treatment of bioptically proved non-alcoholic steatohepatitis (NASH) 5, 6
- Vitamin E: May be considered in the treatment of bioptically proved NASH 5, 6
- Antiobesity medications: May be used in combination with intensive lifestyle interventions or other weight-loss drugs to achieve weight loss and improve NAFLD outcomes 4