From the Guidelines
Steatosis with fat stranding is a condition that requires prompt medical attention and management, focusing on lifestyle modifications and optimal control of cardiometabolic risk factors, as recommended by the most recent guidelines 1.
Key Recommendations
- The management of steatosis with fat stranding should prioritize lifestyle modifications, including weight loss, dietary changes, and regular exercise, as well as optimal management of comorbidities such as type 2 diabetes and obesity 1.
- A stepwise approach using non-invasive tests, such as blood-based scores (e.g., FIB-4) and imaging techniques (e.g., transient elastography), is recommended to rule out advanced fibrosis, which is predictive of liver-related outcomes 1.
- Incretin-based therapies (e.g., semaglutide, tirzepatide) may be considered for adults with steatosis and type 2 diabetes or obesity, as they have been shown to improve liver outcomes 1.
- Resmetirom, a MASH-targeted treatment, may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2), as it has demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1.
Importance of Early Intervention
- Early intervention is crucial to prevent the progression of steatosis with fat stranding to fibrosis and cirrhosis, as inflammatory cytokines can trigger stellate cell activation and collagen deposition in the liver 1.
- Patients with steatosis and fat stranding should be evaluated for metabolic syndrome components, including diabetes, hypertension, and dyslipidemia, as these conditions often coexist and require simultaneous management 1.
Monitoring and Follow-up
- Regular monitoring with liver function tests every 3-6 months is essential to assess the effectiveness of treatment and detect any potential liver-related complications 1.
- Patients with steatosis and fat stranding should be followed up regularly to assess the progression of the disease and adjust treatment as needed 1.
From the Research
Steatosis with Fat Stranding
- Steatosis, also known as fatty liver disease, can occur due to various causes such as non-alcoholic fatty liver disease (NAFLD), alcoholism, chemotherapy, and metabolic, toxic, and infectious causes 2.
- The most common pattern of hepatic steatosis is diffuse, but it can also present in heterogeneous, focal, multinodular, perilesional, perivascular, subcapsular, and lobar forms 2.
- Fat stranding is a term used to describe the appearance of fat infiltration in the liver, which can be seen on imaging studies such as ultrasound, CT, or MRI.
- Vitamin E has been shown to have a potential therapeutic effect on liver enzymes and histology in patients with non-alcoholic steatohepatitis (NASH), a severe form of NAFLD 3, 4.
- Reduced vitamin E levels have been reported in patients with NASH, as well as in those with simple steatosis (SS) 5.
- The association between serum vitamin E levels and SS is not fully understood, but it is thought that reduced vitamin E levels may contribute to the development of liver damage in these patients 5.
Diagnosis and Quantification
- Hepatic steatosis can be diagnosed using imaging studies such as ultrasound, CT, or MRI, and can be quantified using proton-density fat fraction (PDFF) 2.
- PDFF is a non-invasive method that can accurately measure the amount of fat in the liver, and can be used to monitor treatment response in patients with NAFLD 2.
- Magnetic resonance (MR) elastography and functional evaluation with Gd-EOB-DTPA are also becoming important tools for monitoring the progression of NAFLD and the development of cirrhosis 2.
Treatment and Prevention
- Lifestyle modifications, such as weight loss and exercise, are the cornerstone of treatment for hepatic steatosis, and can help to reduce liver fat and improve insulin sensitivity 6.
- Vitamin E supplementation may also have a potential therapeutic effect on liver enzymes and histology in patients with NASH, although more studies are needed to confirm this 3, 4.
- Prevention of hepatic steatosis involves maintaining a healthy lifestyle, including a balanced diet and regular exercise, and avoiding excessive alcohol consumption and other liver toxins 6.