From the Guidelines
Treatment for mild steatosis should primarily focus on lifestyle modifications, including a combination of physical activity and dietary interventions, as this approach has been shown to lead to a greater improvement of metabolic parameters and intrahepatic lipid content (IHLC) 1. The most effective lifestyle modifications include:
- Gradual weight loss of 5-10% of body weight through a balanced diet and regular exercise
- Dietary changes such as reducing calorie intake, limiting processed foods, avoiding sugary beverages, and decreasing saturated fat consumption
- Adoption of Mediterranean or DASH diets, which have been found to be particularly beneficial
- Regular physical activity of at least 150 minutes per week of moderate-intensity exercise
- Elimination or significant reduction of alcohol consumption, as it can worsen liver fat accumulation Management of associated conditions like diabetes, hypertension, and dyslipidemia is also crucial. Currently, no medications are specifically approved for mild steatosis, though vitamin E may be considered in certain cases under medical supervision, as it has been shown to improve steatosis in NASH patients without type 2 diabetes 1. Regular monitoring with liver function tests every 6-12 months is advised to assess the effectiveness of these interventions and prevent progression to more severe forms of liver disease. It is essential to note that the magnitude of weight loss correlates with decreases in intrahepatic triglyceride content, hepatocyte ballooning, and hepatic inflammation, making lifestyle-based therapies the cornerstone of treatment for mild steatosis 1.
From the Research
Treatment Options for Mild Steatosis
- Lifestyle modifications are currently recommended for the treatment of mild steatosis, including weight reduction, exercise, and diet control 2, 3.
- Insulin sensitizers, such as metformin, have been shown to improve metabolic, biochemical, and histological abnormalities in patients with non-alcoholic steatohepatitis (NASH) 4.
- Antioxidants, such as vitamin E, and drugs that interfere with lipid metabolism, such as statins and ezetimibe, may also be effective in the treatment of NASH 5.
- A combination of insulin and metformin has been shown to reduce hepatic steatosis in patients with type 2 diabetes 6.
- Lifestyle modifications, including a 3-month program of weight reduction, exercise, and diet control, have been shown to decrease hepatic steatosis in patients with metabolic-associated fatty liver disease (MAFLD) 3.
Medications for Mild Steatosis
- Insulin sensitizers: metformin 4, 6
- Antioxidants: vitamin E 5
- Lipid-lowering drugs: statins, ezetimibe 5
- Combination therapy: insulin and metformin 6
Lifestyle Modifications for Mild Steatosis
- Weight reduction: aim for a 7-10% reduction in body weight 2
- Exercise: aim for 150-300 minutes/week of moderate-intensity physical activity 2
- Diet control: restrict caloric intake, decrease consumption of commercially produced fructose 2
- Monitoring: use transient elastography (TE) to monitor liver fat and fibrosis changes 3