From the Guidelines
Inhaled corticosteroids (ICS) do not appear to negatively impact fatty liver disease based on current evidence. The most recent and highest quality study on the management of nonalcoholic fatty liver disease (NAFLD) focuses on lifestyle modifications, including diet and exercise, as the cornerstone of therapy 1. This study suggests that weight loss, achieved through a hypocaloric diet and regular physical activity, can improve hepatic steatosis and reduce hepatic inflammation. However, it does not address the specific impact of ICS on NAFLD.
Given the lack of direct evidence on the impact of ICS on fatty liver disease, we can infer from the mechanism of action of ICS that they are unlikely to contribute to metabolic complications like fatty liver disease. ICS medications, such as fluticasone, budesonide, beclomethasone, and mometasone, work by reducing inflammation in the airways with minimal systemic absorption compared to oral corticosteroids 1. In contrast, long-term use of oral or systemic corticosteroids (like prednisone) can promote fat accumulation in the liver and potentially worsen NAFLD.
Therefore, if you have both respiratory issues requiring ICS and fatty liver disease, you can continue using your prescribed ICS as directed without concern about worsening your liver condition. However, it's essential to maintain a healthy lifestyle with proper diet and regular exercise to manage fatty liver disease effectively, regardless of medication use. A Mediterranean diet, minimizing saturated fatty acid intake, and limiting or eliminating consumption of commercially produced fructose, as recommended by the American Gastroenterological Association 1, can be beneficial. Regular physical activity, with a target of 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week, can also enhance the positive effect of a hypocaloric diet on NAFLD 1.
In summary, the key to managing fatty liver disease is lifestyle modification, and ICS do not appear to negatively impact this condition. However, a healthy lifestyle, including a balanced diet and regular exercise, is crucial for effectively managing NAFLD, and patients should follow the recommendations outlined in the most recent and highest quality studies on the topic 1.
From the Research
Impact of Inhaled Corticosteroids (ICS) on Fatty Liver Disease
- There are no direct studies that investigate the impact of ICS on fatty liver disease.
- However, some studies suggest that ICS may have systemic effects, particularly at high doses, which could potentially impact metabolic parameters 2.
- A study from 1999 found that inhaled corticosteroids do not exert any metabolic effect, whereas severe asthma with regular oral corticosteroid therapy is associated with reduced plasma protein and albumin levels 3.
- Another study from 2022 found a dose-dependent association between ICS use and the risk of obesity and metabolic syndrome in asthma patients, suggesting that long-term medium- and high-dose ICS may induce systemic effects 2.
- Other studies have investigated the effects of ICS on various health outcomes, including asthma control, cardiovascular mortality, and all-cause mortality, but none have specifically examined the impact on fatty liver disease 4, 5, 6.