From the Guidelines
A moderate fatty liver requires immediate lifestyle modifications as the primary treatment, focusing on weight loss, dietary changes, and regular exercise to prevent progression to more severe liver disease. The most effective approach is weight loss through a combination of calorie reduction and regular exercise, aiming for a gradual loss of 0.5-1 kg per week, as supported by the 2024 EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) 1. Dietary changes should include limiting processed foods, sugary beverages, and alcohol while increasing consumption of vegetables, fruits, whole grains, and lean proteins. Regular physical activity of at least 150 minutes per week is recommended.
Some key points to consider in the treatment of moderate fatty liver include:
- Weight loss is the key to improvement in the histopathological features of nonalcoholic fatty liver disease (NAFLD), with a loss of at least 5% of body weight associated with improvement in hepatic steatosis (HS) and 7% body weight reduction associated with improvement in the NAFLD activity score (NAS) 1.
- A calorie-restricted diet with a reduction of at least 30% of daily caloric intake or approximately 750-1,000 kcal/day can lead to improvement in insulin resistance (IR) and HS 1.
- The Mediterranean diet, which is higher in monounsaturated fatty acids, has been shown to improve steatosis in patients with NAFLD, even in the absence of weight loss 1.
- Regular monitoring with liver function tests every 6-12 months is crucial to assess the progression of the disease and the effectiveness of treatment.
In terms of pharmacological treatment, there are no FDA-approved medications specifically for fatty liver, but management of underlying conditions like diabetes or high cholesterol may help. Vitamin E (800 IU daily) might benefit non-diabetic patients with more advanced disease. Additionally, incretin-based therapies (e.g., semaglutide, tirzepatide) may be considered for adults with MASLD and type 2 diabetes or obesity, and resmetirom may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) 1.
It is essential to note that if left untreated, moderate fatty liver can progress to inflammation (steatohepatitis), fibrosis, and eventually cirrhosis, highlighting the importance of prompt and effective treatment. The condition develops when excess fat accumulates in liver cells due to factors like insulin resistance, obesity, poor diet, or alcohol consumption, disrupting normal liver function and metabolism.
From the Research
Significance of Moderate Fatty Liver
- A moderate fatty liver, also known as non-alcoholic fatty liver disease (NAFLD), is a condition where excess fat accumulates in the liver of people who drink little or no alcohol 2, 3, 4, 5, 6.
- NAFLD can progress to non-alcoholic steatohepatitis (NASH), which is characterized by inflammation and damage to liver cells, and can lead to advanced fibrosis, cirrhosis, and hepatocellular carcinoma 5, 6.
- The significance of a moderate fatty liver lies in its potential to increase the risk of cardiovascular disease, type 2 diabetes, and liver-related mortality 2, 4.
Treatment of Moderate Fatty Liver
- Lifestyle modifications, including weight loss, a Mediterranean diet, and increased physical activity, are the primary treatment for NAFLD 2, 3, 4, 5, 6.
- Weight loss of 7-10% can lead to significant improvements in liver fat, inflammation, and fibrosis, while even modest weight loss (>5%) can produce important benefits 2, 4.
- A Mediterranean diet, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake, can reduce liver fat even without weight loss 2.
- Physical activity, including aerobic exercise and resistance training, can also reduce hepatic fat and improve liver health, independent of weight loss 3.
- Pharmacological treatment options, such as Vitamin E and Pioglitazone, are available for NAFLD, but lifestyle modifications remain the cornerstone of treatment 5, 6.