From the Guidelines
Yes, non-alcoholic fatty liver disease (NAFLD) can be reversed, especially in its early stages, through lifestyle modifications and management of comorbidities, as recommended by the most recent clinical practice guidelines 1. The most effective approach to reversing NAFLD is through lifestyle modification, primarily including weight loss, dietary changes, and physical exercise, as well as optimal management of comorbidities such as type 2 diabetes and obesity.
- Key aspects of lifestyle modification include:
- Adopting a balanced diet low in processed foods, sugar, and saturated fats
- Increasing consumption of fruits, vegetables, whole grains, and lean proteins
- Regular physical activity, aiming for at least 150 minutes of moderate exercise weekly
- Discouraging alcohol consumption
- Management of comorbidities may involve the use of incretin-based therapies, such as semaglutide or tirzepatide, for type 2 diabetes or obesity, if indicated.
- Bariatric surgery is also an option for individuals with NAFLD and obesity.
- For adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and significant liver fibrosis, consideration should be given to MASH-targeted treatment with resmetirom, which has demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1. The liver's remarkable regenerative capacity allows for recovery and normalization of liver cell function when fat accumulation is reduced, making early lifestyle changes vital for preventing long-term liver damage and progression to more serious conditions like cirrhosis or liver failure.
From the Research
Reversibility of Non-Alcoholic Fatty Liver Disease (NAFLD)
- NAFLD is a liver condition that can be managed and potentially reversed through lifestyle modifications and treatment options 2, 3, 4, 5, 6.
- Lifestyle changes, including weight loss, daily exercise, and diet, have been shown to be effective in improving liver enzymes, reducing liver fat, and improving overall health outcomes in patients with NAFLD 3, 5, 6.
- A multidisciplinary approach to lifestyle modification, including a combination of diet and exercise, has been found to be superior to individual interventions alone in improving liver health and reducing the risk of cardiovascular disease 3, 5.
- Pharmacological treatment options, such as vitamin E and pioglitazone, have also been studied, but the evidence for their effectiveness is limited, and new treatments are being investigated 2, 4, 5.
- Bariatric surgery may be an option for selected patients with NAFLD, particularly those with severe obesity and related comorbidities 4.
Key Findings
- Weight loss of 7-10% has been shown to improve steatosis, inflammation, hepatocyte ballooning, and fibrosis in patients with NAFLD 3.
- Combined exercise and diet interventions have been found to be more effective than individual interventions alone in improving liver enzymes and reducing liver fat 3, 5.
- Lifestyle modifications, including diet and exercise, have been found to be effective in reducing the risk of cardiovascular disease and improving overall health outcomes in patients with NAFLD 3, 5, 6.