From the Guidelines
Management of fatty liver disease should primarily focus on lifestyle modifications, including a hypocaloric diet and regular exercise, aiming for a weight loss of 5-10% of body weight, as recommended by the most recent guidelines 1. The cornerstone of treatment is weight loss through a combination of calorie restriction and regular exercise. Patients should aim for gradual weight loss of 5-10% of body weight, which has been shown to reduce liver fat and inflammation.
- A Mediterranean diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats is recommended, while limiting processed foods, added sugars, and saturated fats.
- Complete alcohol abstinence is essential, particularly for alcoholic fatty liver disease.
- Regular physical activity of at least 150 minutes per week of moderate-intensity exercise helps improve insulin sensitivity and reduce liver fat.
- Management of associated conditions like diabetes, hypertension, and dyslipidemia is crucial, as these can worsen liver disease progression.
- While not FDA-approved for fatty liver disease, medications like vitamin E (800 IU daily) may benefit non-diabetic patients with biopsy-proven non-alcoholic steatohepatitis (NASH) 1.
- Pioglitazone might help diabetic patients with NASH.
- Regular monitoring with liver function tests and imaging is important to track disease progression.
- For advanced cases with cirrhosis, liver transplantation may be considered. These interventions work by reducing fat accumulation in the liver, decreasing inflammation, and improving insulin sensitivity, thereby slowing or reversing the disease process, as supported by recent studies 1.
From the Research
Management of Fatty Liver Disease
The management of fatty liver disease involves a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications, including weight loss, increased physical activity, and dietary changes, are considered the cornerstone of therapy for non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5, 6.
- Weight loss, via increased physical activity and dietary interventions, can potentially ameliorate biochemical, histological, and structural abnormalities of NAFLD 2.
- Increased physical activity has therapeutic effects on NAFLD by reducing hepatic fat independent of weight reduction, and even minimal physical activity may have a beneficial impact on NAFLD 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.
Dietary Modifications
- Dietary modifications are an essential part of the management of NAFLD, and a holistic, multidisciplinary, and individualized approach to disease management is recommended 4.
- The prevention or delay of diabetes onset, reduced cardiovascular events, prevention of cancer, and improved overall mortality are equally important outcomes that can be independently modified by lifestyle change 4.
Pharmacological Interventions
- Pharmacological treatment of NAFLD is still evolving, with vitamin E and pioglitazone being the only approved drugs as of now 5.
- Bariatric surgery can lead to improvement in NASH in morbidly obese patients, and optimal therapy of NAFLD includes a multidisciplinary approach involving management of metabolic syndrome and cardiovascular disease 5.
Diagnosis and Surveillance
- Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications 6.
- Surveillance strategies are necessary to offset the morbidity and mortality of NAFLD, as well as liver and non-liver-related complications 6.