From the Guidelines
To decrease hepatic steatosis, focus on lifestyle changes including weight loss, dietary modifications, and regular exercise, as recommended by the most recent and highest quality study 1. The goal is to lose 5-10% of your body weight through a balanced diet low in processed foods, sugars, and saturated fats.
- Key dietary recommendations include:
- Following the Mediterranean diet
- Minimizing saturated fatty acid intake
- Limiting or eliminating consumption of commercially produced fructose
- Eating more fruits, vegetables, whole grains, lean proteins, and healthy fats like those found in olive oil, avocados, and fatty fish
- Regular physical activity is also crucial, aiming for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise per week, as well as incorporating resistance training exercise 1.
- Limit alcohol consumption significantly or avoid it completely.
- Managing underlying conditions like diabetes and high cholesterol is also essential.
- Medications specifically for fatty liver are limited, but vitamin E may help in non-diabetic patients with confirmed non-alcoholic steatohepatitis, as suggested by older studies 1. These approaches work by reducing fat accumulation in liver cells, decreasing inflammation, and improving insulin sensitivity.
- Consistency is key, as fatty liver improvement typically requires several months of sustained lifestyle changes. It's also important to note that a gradual weight loss of less than 1 kg/week is recommended over rapid weight loss in NAFLD patients with obesity, as rapid weight loss can worsen portal inflammation and fibrosis 1.
From the FDA Drug Label
In patients with type 2 diabetes, the decreased insulin resistance produced by ACTOS results in lower plasma glucose concentrations, lower plasma insulin levels, and lower HbA1c values. ACTOS improves insulin sensitivity in insulin-resistant patients. ACTOS enhances cellular responsiveness to insulin, increases insulin-dependent glucose disposal, improves hepatic sensitivity to insulin, and improves dysfunctional glucose homeostasis
The methods to decrease hepatic steatosis (fatty liver disease) are not directly stated in the provided drug labels. However, improving insulin sensitivity and enhancing cellular responsiveness to insulin may have a positive effect on hepatic steatosis.
- Decreased insulin resistance may lead to lower plasma glucose and insulin levels, which could potentially decrease hepatic steatosis.
- Improved hepatic sensitivity to insulin may also have a beneficial effect on hepatic steatosis. However, the FDA drug label does not provide direct evidence to support a specific method for decreasing hepatic steatosis. 2 2
From the Research
Methods to Decrease Hepatic Steatosis
- Lifestyle modifications, including weight loss of at least 7% to 10% of body weight via a combination of physical exercise and calorie restriction dieting, are considered the first-line treatment for nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) 3
- Physical exercise and diet play a crucial role in achieving the desired weight loss goal and lowering hepatic fat accumulations in the liver 4
- Available drugs such as vitamin E, pioglitazone, and pentoxifylline have borderline efficacy, but are limited by potential side-effects and toxicities, and do not improve liver fibrosis 5
- Vitamin E and pioglitazone are the only drugs providing consistent benefits on liver histology and are currently recommended for NASH 6
- Statins have been shown to produce clinically meaningful results in patients with NAFLD or NASH 6
- Other potential treatment options include metformin, polyunsaturated fatty acids, and omega-3 polyunsaturated fatty acid substitution, although further controlled clinical studies are warranted to establish their efficacy 6, 7
- Surgical or endoscopic surgery for weight loss can be considered in obese patients, depending on degree of excess body weight and comorbidities 3
Treatment Targets
- Reducing inflammation, steatosis, and fibrosis are key targets for treatment, with several new approaches being investigated, including novel drugs that are currently in phase 2 and 3 development 5, 6
- Lifestyle intervention, weight loss, diet, and exercise supported by cognitive behavioural therapy represent the basis of management for non-alcoholic fatty liver disease 7