From the Guidelines
Lifestyle modification, including weight loss, dietary changes, and physical exercise, is the primary treatment for fatty liver disease, with a focus on managing comorbidities and discouraging alcohol consumption. Fatty liver, or hepatic steatosis, is a condition where excess fat builds up in liver cells, with non-alcoholic fatty liver disease (NAFLD) being the most common type, affecting about 25% of adults worldwide 1. The diagnosis of fatty liver disease involves identifying steatotic liver disease in the presence of one or more cardiometabolic risk factors and the absence of harmful alcohol intake, with case-finding strategies using non-invasive tests such as the fibrosis-4 index (FIB-4) and imaging techniques like transient elastography 1.
Key Recommendations
- Weight loss of 7-10% of body weight through a balanced diet low in processed foods, sugar, and saturated fats is recommended 1
- Regular exercise of at least 150 minutes per week of moderate activity is advised 1
- Limiting alcohol consumption is crucial, as alcohol worsens liver damage 1
- Good blood sugar control is essential for those with diabetes 1
- Medications like vitamin E (800 IU daily) may help some patients with more advanced disease, while medications like pioglitazone might be considered in specific cases under medical supervision 1
- Regular monitoring with liver function tests and imaging is important to track progression 1
Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
The management of MASLD involves a stepwise approach using blood-based scores and imaging techniques to rule out advanced fibrosis, which is predictive of liver-related outcomes 1. Optimal management of comorbidities, including the use of incretin-based therapies (e.g., semaglutide, tirzepatide) for type 2 diabetes or obesity, is also advised 1. Bariatric surgery is an option in individuals with MASLD and obesity, and resmetirom may be considered for adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2) 1.
From the Research
Diagnosis of Fatty Liver (Steatosis)
- Fatty liver disease, also known as steatosis, is a condition where excess fat builds up in the liver [ 2, 3, 4, 5, 6 ].
- Non-alcoholic fatty liver disease (NAFLD) is a spectrum of pathologies ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), which can lead to advanced fibrosis, cirrhosis, and hepatocellular carcinoma [ 3 ].
Treatment of Fatty Liver (Steatosis)
- Lifestyle intervention, including weight loss, a Mediterranean diet, and physical activity, is considered effective in treating NAFLD patients [ 2, 6 ].
- Weight loss of ≥10% can induce a near-universal NASH resolution and fibrosis improvement, while modest weight loss (>5%) can also produce important benefits [ 2 ].
- A Mediterranean diet, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake, is recommended for NAFLD patients [ 2 ].
- Pharmacological treatment options, such as Vitamin E and Pioglitazone, are considered for NAFLD patients, and emerging drugs, including FXR agonists, CCR2/CCR5 antagonists, and PPARα/δ agonists, are being investigated [ 3, 4, 5 ].
- Combined exercise and diet interventions are superior to diet or exercise alone in improving liver enzymes and HOMA-IR [ 6 ].