What is the treatment for fatty liver disease?

From the Guidelines

Lifestyle modification using diet and exercise to achieve weight loss is the primary treatment for fatty liver disease, with a goal of losing 7-10% of total body weight to decrease hepatic steatosis, resolve nonalcoholic steatohepatitis, and regress or stabilize fibrosis. According to the American Gastroenterological Association's clinical practice update 1, the best approach to managing nonalcoholic fatty liver disease (NAFLD) involves a hypocaloric diet targeting 1200-1500 kcal/d and regular physical activity, such as 150-300 minutes of moderate-intensity aerobic exercise per week.

Key Recommendations

• A Mediterranean diet with minimized saturated fatty acid intake and limited consumption of commercially produced fructose is recommended 1.
• Adults with NAFLD should aim for a weight loss of 5% of total body weight to decrease hepatic steatosis, 7% to resolve nonalcoholic steatohepatitis, and 10% to regress or stabilize fibrosis 1.
• Regular physical activity, including aerobic exercise and resistance training, can enhance the positive effects of a hypocaloric diet on NAFLD 1.
• Patients with NAFLD should be evaluated and managed for coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease 1.
• Alcohol consumption should be restricted or eliminated from the diets of adults with NAFLD 1.

Additional Considerations

• Sarcopenia is commonly observed in patients with nonalcoholic steatohepatitis cirrhosis, and this group may require specialized dietary and activity management 1.
• Currently, there are no FDA-approved medications specifically for fatty liver disease, but managing related conditions and improving insulin sensitivity can help reduce liver fat, inflammation, and fibrosis.
• Regular medical follow-up is essential to monitor liver health and adjust treatment as needed.

From the Research

Treatment Options for Fatty Liver Disease

The treatment for fatty liver disease, also known as nonalcoholic fatty liver disease (NAFLD), typically involves a combination of lifestyle changes and, in some cases, pharmacological interventions.

• Lifestyle Changes: Weight loss is considered the most effective way to promote liver fat removal, with a target weight loss of 7-10% associated with reduced liver fat, nonalcoholic steatohepatitis (NASH) remission, and reduction of fibrosis 2, 3.
• Dietary Modifications: A diet with a reduction of 500 to 1000 calories per day, containing 15% protein, 55% carbohydrates, and 30% fat, has been shown to be effective in improving insulin resistance, biochemical parameters of metabolic syndrome, and degree of hepatic steatosis in patients with NAFLD 4.
• Exercise: Regular physical activity is also recommended as part of a comprehensive approach to managing NAFLD, although the specific benefits of exercise on liver fat and inflammation are not as well-studied as those of weight loss and dietary changes.

Pharmacological Interventions

Several pharmacological agents have been studied for the treatment of NAFLD and NASH, including:

• Vitamin E: Has been shown to improve histology in NASH, but its use is limited by safety concerns, particularly in patients with prostate cancer 5, 3, 6.
• Pioglitazone: Improves liver histology, including fibrosis, and can be considered in patients with or without diabetes 5, 3, 6.
• Glucagon-like peptide-1 (GLP-1) antagonists: May be beneficial in NASH, but more studies are needed to confirm their efficacy 3.
• Statins: Have been shown to produce clinically meaningful results in patients with NAFLD or NASH, although their effects on liver histology are not as well-studied as those of other agents 6.
• Bariatric surgery: Can result in significant weight loss and improvement in liver fat and inflammation, although it is typically reserved for patients with severe obesity and other comorbidities 2, 3.

Emerging Therapies

Several novel agents are being investigated for the treatment of NAFLD and NASH, including:

• Farnesoid X receptor agonists: Such as obeticholic acid, which has shown significant histological improvements in steatohepatitis and fibrosis 5.
• Other agents targeting inflammation, steatosis, and fibrosis: Are being evaluated in experimental models and early-stage clinical trials, although more research is needed to determine their safety and efficacy in humans 6.