From the Guidelines
Early onset fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD), requires a comprehensive lifestyle approach for management, with the primary recommendation being weight management through a balanced diet and regular physical activity, as stated in the most recent study 1. The primary goal of treatment is to reduce liver fat, inflammation, and fibrosis, thereby preventing progression to cirrhosis and liver-related complications.
- Key components of lifestyle modification include:
- A Mediterranean-style diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, while limiting processed foods, sugary beverages, and refined carbohydrates, as recommended by 1 and 1.
- Regular exercise of at least 60 minutes daily of moderate-to-vigorous physical activity, as suggested by 1.
- No specific medications are FDA-approved for NAFLD, though pioglitazone and some glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been shown to be effective in treating steatohepatitis and may slow fibrosis progression, as stated in 1.
- Statin therapy should be initiated or continued for cardiovascular risk reduction as clinically indicated, as it appears to be safe in adults with type 2 diabetes and NASH, including in the presence of compensated cirrhosis, according to 1.
- Regular monitoring with liver function tests every 3-6 months and occasional imaging is important to assess disease progression and response to treatment. The disease develops when excess fat accumulates in liver cells due to insulin resistance, often associated with obesity, poor diet, sedentary lifestyle, and sometimes genetic factors. Without intervention, early onset fatty liver disease can progress to inflammation, fibrosis, and potentially cirrhosis, making early lifestyle modifications crucial for preventing long-term liver damage, as highlighted in 1.
From the Research
Definition and Prevalence of Early Onset Fatty Liver Disease
- Non-alcoholic fatty liver disease (NAFLD) is a liver condition that is increasing worldwide and expected to become the number one cause of cirrhosis and hepatocellular carcinoma in the next 5 years 2.
- NAFLD affects at least 25% of the general population and is an increasingly important cause of cirrhosis and hepatocellular carcinoma 3.
- The prevalence of NAFLD is increasing, with up to 30% of adults in the United States affected 4.
Risk Factors and Diagnosis
- Individuals with obesity are at highest risk of NAFLD, with other established risk factors including metabolic syndrome and type 2 diabetes mellitus 4.
- Abdominal ultrasonography is the most commonly used method to diagnose fatty liver, with simple fibrosis scores having high negative predictive values in excluding advanced liver fibrosis and future liver-related events 3.
- Liver biopsy should be considered for patients at increased risk of fibrosis and when other liver disorders cannot be excluded with noninvasive tests 4.
Treatment and Management
- Weight loss through diet and exercise is the primary treatment for NAFLD, with a 7 to 10% reduction in weight improving steatosis, inflammation, hepatocyte ballooning, and fibrosis 2.
- Combined exercise with diet seems to elicit greater reductions in liver enzymes and HOMA-IR than diet or exercise alone 2.
- Other treatments, such as bariatric surgery, vitamin E supplements, and pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues, have shown potential benefit but are not considered routine treatments 4, 5.
Current Research and Future Directions
- There are no approved pharmacological treatments for NASH/NAFLD, with many clinical trials underway to evaluate the efficacy of various agents 5.
- Pioglitazone is the only agent that has shown consistent benefit and efficacy in clinical trials, with other drugs showing mixed results 5.
- Further research is needed to identify effective treatments for NAFLD and NASH, with a focus on alternative pathophysiological pathways 5.