From the Guidelines
Liver steatosis should be managed through lifestyle modifications, including weight loss, dietary changes, and physical exercise, as well as optimal management of comorbidities, such as type 2 diabetes and obesity, to reduce the risk of progression to fibrosis, cirrhosis, and liver failure. The management of liver steatosis, also known as metabolic dysfunction-associated steatotic liver disease (MASLD), involves a stepwise approach using non-invasive tests, such as blood-based scores (e.g., FIB-4) and imaging techniques (e.g., transient elastography), to rule out advanced fibrosis, which is predictive of liver-related outcomes 1.
Key Recommendations
- Lifestyle modification, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption, is essential for managing MASLD 1.
- Optimal management of comorbidities, such as type 2 diabetes and obesity, using incretin-based therapies (e.g., semaglutide, tirzepatide), is recommended 1.
- Bariatric surgery is an option for individuals with MASLD and obesity 1.
- Resmetirom, a MASH-targeted treatment, may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) 1.
Importance of Early Intervention
Early intervention is crucial for preventing long-term liver damage, as liver steatosis can progress to fibrosis, cirrhosis, and liver failure if left untreated 1. Regular monitoring with liver function tests and imaging every 6-12 months is recommended to track progression and adjust treatment plans as needed. By prioritizing lifestyle modifications and optimal management of comorbidities, individuals with liver steatosis can reduce their risk of developing advanced liver disease and improve their overall quality of life.
From the Research
Definition and Prevalence of Liver Steatosis
- Liver steatosis, also known as non-alcoholic fatty liver disease (NAFLD), is a metabolic liver disorder characterized by the accumulation of fat in the liver cells 2.
- It is estimated to affect 2-6% of the general population 2.
- NAFLD can progress to non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis [(2,3)].
Pathogenesis of Liver Steatosis
- The pathogenesis of NAFLD involves the dysfunction of lipid metabolism within hepatocytes, caused by genetic factors, diet, and insulin resistance 4.
- Lipotoxicity, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum stress contribute to hepatocyte injury and death, leading to inflammation and immune dysfunction in the liver 4.
- The gut-liver axis, adipose-liver axis, and renin-angiotensin system (RAS) may be dysregulated and impaired in the development of NASH and liver fibrosis 4.
Treatment and Management of Liver Steatosis
- Lifestyle modification, including weight loss, physical activity, and dietary changes, is the primary therapy for the management of NAFLD [(5,6)].
- Weight reduction of ≥10% can induce a near-universal NASH resolution and fibrosis improvement 5.
- A Mediterranean diet, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake, is recommended for NAFLD 5.
- Physical activity, including aerobic and resistance training, has therapeutic effects on NAFLD, independent of weight reduction 6.
Association with Metabolic Syndrome
- NAFLD is associated with metabolic syndrome, which is characterized by insulin resistance, oxidative stress, and adipokine dysfunction 3.
- The treatment of NAFLD should address the underlying metabolic abnormalities, including insulin resistance and dyslipidemia 3.
- Population interventions to change lifestyles and diet patterns are necessary to reduce the risk of NAFLD and metabolic syndrome 3.