From the Guidelines
The treatment for patients with fatty liver and cirrhosis should focus on lifestyle modifications, including weight loss of 7-10% of body weight through a balanced diet and regular exercise, as well as managing metabolic risk factors, such as controlling diabetes and hypertension, and using statins for dyslipidemia, as recommended by the most recent guidelines 1.
Lifestyle Modifications
- Weight loss of 7-10% of body weight through a balanced diet, such as the Mediterranean diet, and regular exercise, with a target of 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week 1
- Alcohol cessation is essential for all patients, particularly those with alcoholic liver disease
- Regular physical activity should be considered for patients with NAFLD, with a target of 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week 1
Managing Metabolic Risk Factors
- Controlling diabetes with medications like pioglitazone or GLP-1 receptor agonists, such as semaglutide, which has been shown to have a beneficial effect on liver histology and fibrosis 1
- Treating hypertension and using statins for dyslipidemia
- Vitamin E (800 IU/day) may benefit non-diabetic patients with non-alcoholic steatohepatitis (NASH) 1
Cirrhosis Management
- Treatment includes diuretics like spironolactone and furosemide for ascites, beta-blockers such as propranolol or nadolol for preventing variceal bleeding, and lactulose for hepatic encephalopathy
- Patients should be vaccinated against hepatitis A, hepatitis B, pneumococcus, and influenza
- Regular screening for hepatocellular carcinoma with ultrasound every 6 months is recommended
- For end-stage liver disease, liver transplantation may be considered
Additional Considerations
- Bariatric surgery may be an option for individuals with NAFLD and obesity, as it has been shown to have a profound effect on weight loss and liver histology 1
- Patients with NAFLD should be evaluated for coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, and these comorbidities should be managed aggressively 1
From the Research
Treatment for Fatty Liver and Cirrhosis
The treatment for patients with fatty liver and cirrhosis involves a combination of lifestyle modifications and pharmacological therapies.
- Lifestyle modifications:
- Weight loss: A weight loss of 7-10% is recommended to reduce liver fat and improve nonalcoholic steatohepatitis (NASH) 2.
- Diet: A Mediterranean diet, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake, is recommended for patients with nonalcoholic fatty liver disease (NAFLD) 3, 4.
- Physical activity: Regular physical activity is essential for improving cardio-metabolic health and reducing the risk of NAFLD and NASH 3, 2.
- Pharmacological therapies:
- Non-selective beta-blockers: Effective in reducing variceal re-bleeding risk in cirrhotic patients with moderate/large varices 5.
- Gut-selective antibiotic rifaximin: Effective for secondary prophylaxis of hepatic encephalopathy and may have potential superiority to norfloxacin for secondary prevention of spontaneous bacterial peritonitis 5.
- Diuretics: Remain the mainstay of uncomplicated ascites treatment 5.
- Statins: Demonstrated safety in compensated cirrhosis and may have protective effects upon fibrosis progression, decompensation, and mortality 5.
Management of Cirrhosis and its Complications
The management of cirrhosis and its complications involves a comprehensive approach, including:
- Complication-guided pharmacological therapy: The mainstay of long-term management of cirrhosis 5.
- Aetiology management: Essential for preventing further liver damage and improving patient outcomes.
- Nutritional optimisation: Important for maintaining a healthy weight and preventing malnutrition.
- Patient education: Crucial for promoting lifestyle modifications and adherence to pharmacological therapies.