From the Guidelines
To manage steatosis (fatty liver disease) with fibrosis, the primary treatment should focus on lifestyle modifications, including a hypocaloric diet and regular physical activity, with the goal of achieving a weight loss of 7%-10% to improve fibrosis. This approach is supported by the most recent and highest quality study, which emphasizes the importance of lifestyle interventions in managing nonalcoholic fatty liver disease (NAFLD) 1.
Key Components of Lifestyle Modifications
- A hypocaloric diet targeting 1200–1500 kcal/d or a reduction of 500–1000 kcal/d from baseline, with a focus on the Mediterranean diet, minimizing saturated fatty acid intake, and limiting or eliminating consumption of commercially produced fructose 1
- Regular physical activity, aiming for 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic exercise per week, with resistance training exercise as a complementary approach 1
- Weight loss of at least 3%-5% of body weight to improve steatosis, but a greater weight loss (7%-10%) is needed to improve the majority of the histopathological features of NASH, including fibrosis 1
Additional Considerations
- Control related conditions like diabetes, high blood pressure, and high cholesterol through proper medication and monitoring 1
- Limit alcohol consumption completely or significantly, as it worsens liver damage 1
- Stay well-hydrated and avoid unnecessary medications that may stress the liver
- Regular follow-up with your healthcare provider is important to monitor liver function and adjust your treatment plan as needed
Pharmacological Interventions
While lifestyle modifications are the primary treatment, certain pharmacological interventions may be considered in specific cases, such as the use of vitamin E (800 IU daily) in non-diabetic patients with more advanced disease, or the use of GLP-1 receptor agonists and SGLT2 inhibitors in patients with type 2 diabetes and NAFLD 1. However, these interventions should be individualized and used with caution, and their effectiveness in improving liver histology and preventing disease progression remains to be established.
From the Research
Treatment for Steatosis (Fatty Liver Disease) with Fibrosis
The treatment for steatosis (fatty liver disease) with fibrosis involves lifestyle modifications, including:
- Weight loss: Studies have shown that weight loss is the most effective way to promote liver fat removal and improve liver health 2, 3.
- Dietary changes: A Mediterranean diet and hypocaloric dietary interventions with foods high in unsaturated fatty acids have been shown to improve liver steatosis and transaminases 4.
- Increased physical activity: Physical activity has therapeutic effects on non-alcoholic fatty liver disease (NAFLD) by reducing hepatic fat independent of weight reduction 5.
Pharmacological Options
Current guidelines recommend the use of pioglitazone or vitamin E in patients with non-alcoholic steatohepatitis (NASH) and significant fibrosis, but the use of both remains off-label 6. Several medications are currently in phase 3 clinical trials, including:
- Obeticholic acid (a farnesoid X receptor agonist)
- Elafibranor (a peroxisome proliferator activated receptor [PPAR]-α/δ dual agonist)
- Cenicriviroc (a CC chemokine receptor antagonist)
- MSDC-0602K (a PPAR sparing modulator)
- Selonsertib (an apoptosis signal-regulating kinase-1 inhibitor)
- Resmetirom (a thyroid hormone receptor agonist) 6.
Lifestyle Intervention
Lifestyle intervention has been shown to be effective in treating NAFLD in patients with morbid obesity, with improvements in liver steatosis, damage, and fibrosis 3. A weight loss of >10% has been associated with better treatment response 3.