What is the treatment for fatty liver disease?

Treatment of Fatty Liver Disease

The cornerstone of fatty liver disease treatment is lifestyle modification focused on weight loss of 7-10% through caloric restriction and regular physical activity, which has been shown to improve liver histology, reduce inflammation, and even improve fibrosis. 1

Risk Stratification

• All patients with NAFLD need lifestyle modifications and treatment for comorbidities regardless of disease severity 2
• Patients should be risk-stratified using non-invasive tests like FIB-4 score, liver stiffness measurement (LSM), or NAFLD Fibrosis Score 3
• Low risk: FIB-4 <1.3, LSM <8.0 kPa, or liver biopsy fibrosis stage F0-F1 3
• Intermediate risk: FIB-4 1.3-2.67, LSM 8.0-12.0 kPa 3
• High risk: FIB-4 >2.67, LSM >12.0 kPa 3

Dietary Interventions

• Implement a hypocaloric diet with 500-1000 kcal energy deficit to achieve weight loss of 500-1000g/week 1, 3
• A Mediterranean diet pattern is recommended as it can reduce liver fat even without weight loss 1, 4
• Aim for 7-10% weight loss to improve hepatic inflammation and fibrosis; even 5-7% weight loss can significantly reduce intrahepatic fat content 1
• Avoid processed foods and beverages with added fructose 1, 3
• Replace saturated fats with monounsaturated and polyunsaturated fats, especially omega-3 fatty acids 1
• Limit or avoid alcohol consumption completely, especially in those with advanced disease 1, 3

Physical Activity Recommendations

• Engage in at least 150-300 minutes of moderate-intensity aerobic exercise per week or 75-150 minutes of vigorous-intensity exercise 1, 3
• Include resistance training as a complement to aerobic exercise 1
• Even modest increases in activity can improve liver health - any physical activity is better than none 1, 5
• Exercise alone, even without weight loss, can reduce hepatic fat content by improving insulin sensitivity 1, 5

Weight Loss Guidelines

• Loss of 3-5% of body weight improves steatosis 6
• Loss of 7-10% of body weight improves inflammation 1, 7
• Loss of 10% or more of body weight may improve fibrosis 1, 8
• Maintain gradual weight loss (maximum 1kg/week) as rapid weight loss may worsen liver disease 2, 6

Management of Comorbidities

• Treat diabetes with medications that promote weight loss and reduce cardiovascular risk 2
• Consider GLP-1 receptor agonists (like semaglutide) for diabetes management, which have shown benefits for NASH 2, 3
• Statins are safe and effective for managing dyslipidemia in patients with fatty liver disease, including those with compensated cirrhosis 2
• Treat hypertension according to standard guidelines 2

Advanced Interventions

• Consider referral for bariatric surgery in patients with obesity who meet eligibility criteria 2, 3
• Bariatric surgery can achieve NASH resolution in up to 80% of subjects at 1-year follow-up 8
• Patients with cirrhosis require surveillance for hepatocellular carcinoma 6, 3

Monitoring and Follow-up

• Low-risk patients should have annual follow-up with repeated non-invasive tests 3
• Intermediate and high-risk patients should have more frequent monitoring (every 6 months) 3
• Liver biopsy remains the gold standard for characterizing liver histology but should be reserved for patients who would benefit most from diagnostic, therapeutic guidance, and prognostic perspectives 3

Common Pitfalls and Caveats

• Rapid weight loss (>1kg/week) should be avoided as it may worsen liver disease 1, 2
• Sustainability is key - choose dietary and exercise regimens that can be maintained long-term 1
• No specific pharmacotherapy has been approved by regulatory agencies specifically for NAFLD treatment 1
• Metformin is not recommended as a specific treatment for NAFLD as it has no significant effect on liver histology 1, 6