From the Guidelines
The workup and treatment of hepatic steatosis (fatty liver disease) should begin with lifestyle modifications, including a hypocaloric diet and regular exercise, as recommended by the most recent guidelines 1. The diagnosis of hepatic steatosis typically involves a thorough clinical evaluation, including medical history, physical examination, and laboratory tests such as liver function tests, lipid profile, and blood glucose levels. Imaging studies like ultrasound, CT scan, or MRI can confirm the presence of fat in the liver. In some cases, a liver biopsy may be necessary to determine the severity of the condition and rule out other liver diseases.
Key aspects of treatment include:
- Weight loss of 7-10% of body weight through a balanced diet and regular exercise, as this can reduce liver fat and inflammation 1
- Dietary changes, such as limiting processed foods, sugar, and saturated fats, and increasing consumption of fruits, vegetables, whole grains, and lean proteins 1
- Avoiding alcohol completely, especially in alcoholic fatty liver disease 1
- Management of associated conditions like diabetes, hypertension, and dyslipidemia, which is essential for improving outcomes in patients with hepatic steatosis 1
- Consideration of pharmacologic treatments, such as incretin-based therapies for type 2 diabetes or obesity, and resmetirom for non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with significant liver fibrosis 1
Lifestyle modification, including weight loss, dietary changes, and physical exercise, is the cornerstone of treatment for hepatic steatosis, and should be applied to all patients, regardless of the degree of inflammation or fibrosis 1. Regular follow-up with healthcare providers is important to monitor liver function and disease progression.
From the Research
Workup of Hepatic Steatosis
- Hepatic steatosis is defined as intrahepatic fat of at least 5% of liver weight 2
- The workup of hepatic steatosis involves identifying the underlying cause of the condition, which can include nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) 3, 4
- Liver biopsy is the only accepted method for diagnosis of nonalcoholic steatohepatitis (NASH), a subtype of NAFLD 3
Treatment of Hepatic Steatosis
- Lifestyle modification is the mainstay of treatment for hepatic steatosis, including dietary changes and exercise, with the primary goal being weight loss 3, 5
- Substantial improvement in histologic outcomes, including fibrosis, is directly correlated with increasing weight loss 5
- Bariatric surgery may be indicated to achieve and maintain the necessary degree of weight loss required for therapeutic effect 3
- Medications such as pioglitazone may be effective in patients with NASH, particularly those with type 2 diabetes 6
- Xanthine oxidase inhibitors, such as allopurinol and febuxostat, may also be beneficial in improving steatosis in patients with MASLD 4
Management of Hepatic Steatosis
- Early identification and targeted treatment of patients with hepatic steatosis are needed to improve patient outcomes 3
- Patients with hepatic steatosis should be directed towards intensive lifestyle modification to promote weight loss and referral for bariatric surgery as indicated for management of obesity and metabolic disease 3
- Regular monitoring of liver function and histologic features is necessary to assess the effectiveness of treatment and prevent disease progression 5, 6