What is the treatment for Non-Alcoholic Fatty Liver Disease (NAFLD)?

From the Guidelines

The primary treatment for Non-Alcoholic Fatty Liver Disease (NAFLD) focuses on lifestyle modifications, particularly weight loss through diet and exercise, as recommended by the American Gastroenterological Association 1.

Key Recommendations

• Patients should aim for gradual weight reduction of 7-10% of body weight, which has been shown to reduce liver fat and inflammation 1.
• A Mediterranean diet rich in fruits, vegetables, whole grains, olive oil, and lean proteins is recommended, while limiting processed foods, added sugars, and saturated fats 1.
• Regular physical activity of at least 150 minutes per week of moderate-intensity exercise should be incorporated 1.
• Currently, there are no FDA-approved medications specifically for NAFLD, though vitamin E (800 IU daily) may be considered for non-diabetic patients with biopsy-proven non-alcoholic steatohepatitis (NASH) 1.
• For patients with diabetes, medications like pioglitazone or GLP-1 receptor agonists may provide secondary benefits for liver health 1.
• Management of comorbidities such as diabetes, hypertension, and dyslipidemia is essential 1.
• Alcohol should be avoided completely, as it can worsen liver damage 1.

Additional Considerations

• A hypocaloric diet should be considered as treatment for patients with normal-weight NAFLD with a lower target weight-loss threshold of 3%–5% 1.
• Patients with normal-weight NAFLD can significantly benefit from intensive lifestyle intervention (ILI) and weight loss through improvement of hepatic fat, decreased waist circumference, and decreased low-density lipoprotein levels 1.
• The durability of weight loss and the impact of weight regain in normal-weight NAFLD is not known 1.

From the Research

Treatment for Non-Alcoholic Fatty Liver Disease (NAFLD)

The treatment for NAFLD primarily focuses on lifestyle modifications, as there are no approved pharmacologic agents for the disease. The key components of treatment include:

• Weight loss: Aiming for a weight loss of 5% to >10% through healthy diet and increased physical activity/exercise 2
• Dietary changes: Encouraging a healthy diet to reduce hepatic fat and improve metabolic parameters 3, 4
• Increased physical activity: Recommending daily exercise, such as aerobic activity and resistance training, to reduce hepatic fat and improve overall health 5, 3

Lifestyle Modifications

Lifestyle modifications are the cornerstone of treatment for NAFLD. These modifications include:

• Combined exercise and diet: This approach has been shown to be more effective than diet or exercise alone in improving liver enzymes and metabolic parameters 3
• Behavioral strategies: Using behavioral strategies to support lifestyle behavior change, such as counseling and motivation, can be effective in promoting weight loss and improving overall health 4

Pharmacologic Therapies

While there are no approved pharmacologic therapies for NAFLD, certain medications may be used to manage related conditions, such as:

• Antidiabetic drugs: Metformin, glucagon-like peptide-1 analogues, and sodium-dependent glucose cotransporter inhibitors may be used to manage abnormal metabolic parameters in patients with NAFLD 6
• Statins: Statins may be used to reduce the risk of cardiovascular morbidity and mortality in patients with NAFLD and dyslipidemia, but their use specifically for treatment of NASH needs further evaluation 6

Additional Considerations

For patients with NAFLD who are overweight or obese, healthcare providers may consider a trial of FDA-approved anti-obesity medications as adjunct therapy to provide further preventative and therapeutic options 2. Additionally, vitamin E and pioglitazone may be recommended for patients with confirmed NASH, but their long-term safety and efficacy need to be carefully considered 6.