From the Guidelines
Individuals with fatty liver disease should receive standard adult vaccinations, with a special emphasis on hepatitis B vaccination, as recommended by the 2017 adult immunization schedule 1.
Recommended Vaccinations
- Hepatitis B vaccination is recommended for adults with chronic liver disease, including fatty liver disease, as it can help prevent additional liver damage 1.
- Annual influenza vaccination and pneumococcal vaccination (Prevnar 13 followed by Pneumovax 23 at least one year later) are also important for individuals with fatty liver disease.
Management Strategies
- Weight loss of 7-10% of body weight through a combination of calorie restriction (reducing daily intake by 500-1000 calories) and regular exercise (150 minutes of moderate activity weekly) is recommended for individuals with fatty liver disease, as it can help improve hepatic steatosis and reduce hepatic inflammation 1.
- A hypocaloric diet, such as the Mediterranean diet, and regular physical activity can help improve liver function and reduce the risk of progression to advanced liver disease 1.
- Alcohol consumption should be restricted or eliminated, and regular monitoring of liver enzymes every 3-6 months is recommended 1.
- Blood sugar and cholesterol management are essential for comorbid conditions, such as diabetes and cardiovascular disease 1.
Medications
- No FDA-approved medications exist specifically for fatty liver disease, but vitamin E (800 IU daily) may benefit non-diabetic patients with biopsy-proven NASH, and pioglitazone (30-45 mg daily) might help patients with diabetes and NASH 1.
- Resmetirom, a MASH-targeted treatment, has demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile, and may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) 1.
From the Research
Recommended Vaccinations for Fatty Liver Disease
- Hepatitis A vaccination is recommended for individuals with chronic liver disease, including fatty liver disease, as it can help prevent acute hepatitis A infection, which can lead to high rates of morbidity and mortality in this population 2.
- Hepatitis B vaccination is also recommended, as it can help prevent hepatitis B infection, which can accelerate the progression of chronic liver disease to cirrhosis, decompensated liver disease, and hepatocellular carcinoma 2.
- Influenza vaccination is recommended annually for individuals with chronic liver disease, as it can help prevent hepatic decompensation and other complications associated with influenza infection 3, 4.
- Pneumococcal vaccination is recommended for individuals with chronic liver disease, as it can help prevent pneumococcal infections, which can be severe in this population 3, 4.
Management Strategies for Fatty Liver Disease
- Early vaccination is crucial, as vaccine efficacy declines with the progression of liver disease 3, 2, 4.
- Inactivated or killed-type vaccinations are preferred over live, attenuated vaccinations, especially in patients with cirrhosis or those who have undergone liver transplantation 3, 4.
- Patients with fatty liver disease should be vaccinated against hepatitis A and B, influenza, and pneumococcus, as recommended by the Advisory Committee on Immunization Practices (ACIP) 4.
- Healthcare providers should be aware of the barriers to vaccination in this population, including inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement, and vaccine misinformation, and take steps to address these barriers 4.
Special Considerations for Fatty Liver Disease
- Obese individuals with nonalcoholic fatty liver disease (NAFLD) may have reduced immune responses to hepatitis B vaccination, and therefore, may require special consideration when it comes to vaccination strategies 5.
- NAFLD patients with high-risk obesity may have lower vaccine-specific immune responses and may require more intensive vaccination strategies 5.