From the Guidelines
Lifestyle modification using diet and exercise to achieve weight loss is the primary treatment for steatosis (fatty liver disease), with a goal of losing 5-10% of total body weight to decrease hepatic steatosis and improve liver health. This approach is supported by the American Gastroenterological Association's clinical practice update on lifestyle modification for nonalcoholic fatty liver disease (NAFLD) 1. The recommended diet includes a hypocaloric intake of 1200-1500 kcal/d, with a focus on the Mediterranean diet, minimizing saturated fatty acid intake, and limiting or eliminating consumption of commercially produced fructose.
Key components of the treatment plan include:
- Aiming for a weight loss of 5% of total body weight to decrease hepatic steatosis, 7% for nonalcoholic steatohepatitis resolution, and 10% for fibrosis regression or stability 1
- Implementing a hypocaloric diet for non-Asian patients with body mass index 24 kg/m² and for Asian patients with body mass index 26 kg/m², with a lower target weight-loss threshold of 3%-5% 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, and considering resistance training exercise as a complementary approach 1
- Managing coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, aggressively 1
- Restricting or eliminating alcohol consumption from the diet 1
By following this treatment plan, patients with steatosis can reduce fat accumulation in the liver, decrease inflammation, and improve liver function, ultimately reducing the risk of disease progression and improving overall health outcomes.
From the Research
Treatment Options for Steatosis (Fatty Liver Disease)
The treatment for steatosis, also known as fatty liver disease, primarily involves lifestyle modifications and, in some cases, pharmacological interventions.
- Lifestyle modifications are considered the first-line therapy for non-alcoholic fatty liver disease (NAFLD) and include:
- Dietary changes: Following a Mediterranean diet can reduce liver fat even without weight loss 2. A diet characterized by reduced carbohydrate intake and increased monounsaturated and omega-3 fatty acid intake is recommended.
- Exercise: Regular physical activity, including daily exercise, can improve liver enzymes, quality of life, and cardiorespiratory fitness 3.
- Weight loss: A weight reduction of 7-10% can improve steatosis, inflammation, hepatocyte ballooning, and fibrosis 3, 4.
Pharmacological Interventions
While lifestyle modifications are the primary approach, certain pharmacological treatments may be considered:
- Pioglitazone and vitamin E are currently recommended by international societies for the treatment of NAFLD, although they are not without adverse effects 5, 6.
- Glucagon-like peptide-1 (GLP-1) antagonists may be beneficial in non-alcoholic steatohepatitis (NASH), but more studies are needed before they can be recommended 4.
- Bariatric surgery can result in improvement in liver fat and inflammation, particularly in patients with significant weight loss 4.
Combination Therapy
Combining diet and exercise has been shown to be more effective than either intervention alone in improving liver enzymes and insulin resistance 3.
Importance of Lifestyle Modifications
Lifestyle modifications, including dietary changes and regular exercise, are crucial for the management of NAFLD and should be accompanied by strategies to avoid relapse and weight regain 2, 3.