What is the best management of Steatosis (Fatty Liver Disease)?

From the Guidelines

The best management of Steatosis (Fatty Liver Disease) primarily involves lifestyle modifications, with a focus on weight loss through a balanced diet and regular exercise, aiming for a gradual 5-10% reduction in body weight, as recommended by the most recent and highest quality study 1.

Key Recommendations

• Weight loss is the key to improvement in the histopathological features of NASH, with a 5% body weight reduction associated with improvement in hepatic steatosis, 7% reduction associated with NASH resolution, and 10% reduction associated with fibrosis regression or stability 1.
• A hypocaloric diet targeting 1200-1500 kcal/d or a reduction of 500-1000 kcal/d from baseline is recommended for clinically significant weight loss 1.
• The Mediterranean diet is recommended, with a focus on minimizing saturated fatty acid intake and limiting or eliminating consumption of commercially produced fructose 1.
• Regular physical activity, with a target of 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week, is recommended, with resistance training exercise as a complementary option 1.
• Managing comorbidities like diabetes, hypertension, and dyslipidemia is crucial, with medications like pioglitazone or vitamin E sometimes prescribed for NASH in select patients 1.

Lifestyle Modifications

• Dietary changes should include limiting processed foods, refined carbohydrates, and saturated fats, while increasing consumption of fruits, vegetables, whole grains, and lean proteins.
• Alcohol abstinence is essential, particularly for alcoholic fatty liver disease.
• Regular monitoring with liver function tests and imaging is important to track disease progression.

Benefits of Lifestyle Modifications

• Reducing liver fat accumulation
• Decreasing inflammation
• Improving insulin sensitivity
• Preventing progression to more severe liver damage like cirrhosis or liver failure By following these recommendations, patients with Steatosis (Fatty Liver Disease) can improve their liver health and reduce the risk of progression to more severe liver damage.

From the Research

Management of Steatosis (Fatty Liver Disease)

The management of steatosis, also known as fatty liver disease, involves lifestyle modifications, including diet, physical activity, and exercise.

• Weight loss is a key component of management, with reductions of ≥10% inducing near-universal non-alcoholic steatohepatitis resolution and fibrosis improvement by at least one stage 2.
• Modest weight loss (>5%) can also produce important benefits on the components of the NAFLD activity score (NAS) 2.
• The Mediterranean diet is recommended as the diet of choice for the treatment of NAFLD, characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake 2, 3.
• Physical activity and exercise are also essential, with aerobic activity and resistance training having similar effects on NAFLD 4.
• A 'triple hit behavioural phenotype' of sedentary behaviour, low physical activity, and poor diet should be avoided, and strategies to avoid relapse and weight regain should be implemented 2.

Lifestyle Modifications

Lifestyle modifications, including weight loss, dietary changes, and increased physical activity, are the treatment of choice for NAFLD 5, 4.

• Weight loss ≥ 7-10% is central to lifestyle management, but liver and cardiometabolic benefits are attainable with improved diet quality and exercise even without weight loss 6.
• Dietary management emphasizes energy deficit and improved diet quality, especially the Mediterranean diet, with sociocultural adaptations to meet preferences 6.
• Increasing physical activity and reducing sedentary behavior can prevent MAFLD, with strongest evidence supporting regular structured moderate-vigorous aerobic exercise for 150-240 min/week 6.

Dietary Recommendations

The Mediterranean diet is the most recommended dietary pattern for NAFLD, with individual components such as olive oil, fish, nuts, whole grains, fruits, and vegetables having beneficial effects on NAFLD 3.

• The Mediterranean diet has an established superiority in long-term weight reduction over low-fat diets and improves metabolic status and steatosis even without weight loss 3.
• Consumption of components that characterize a Western dietary pattern, such as soft drinks, fructose, meat, and saturated fatty acids, has been shown to have detrimental associations with NAFLD 3.