From the Guidelines
Hepatic steatosis, commonly known as fatty liver disease, is a condition where excess fat builds up in your liver cells, and the first line treatment focuses on lifestyle modifications, including a modest weight loss of 3-5% through a combination of regular exercise and a balanced diet low in processed foods, sugar, and saturated fats, as recommended by the most recent study 1. This condition can develop without causing symptoms initially, but if left untreated, it may lead to liver inflammation, scarring, and eventually liver damage. The key aspects of lifestyle modifications include:
- Aiming for a weight loss of 3-5% of total body weight, which has been found to improve steatosis 1
- Engaging in regular exercise, such as at least 150 minutes of moderate activity per week, which can improve histology regardless of weight change 1
- Following a balanced diet low in processed foods, sugar, and saturated fats, and limiting fructose and sugar-sweetened beverages 1
- Reducing alcohol consumption, as alcohol can worsen liver fat accumulation
- Maintaining good blood sugar control, especially for those with diabetes No specific medications are approved specifically for fatty liver disease, though your doctor might recommend vitamin E (800 IU daily) if you don't have diabetes or heart disease. These lifestyle changes work by reducing the amount of fat being stored in your liver and improving your body's ability to process fats effectively. Most patients see improvement in liver fat levels within 3-6 months of consistent lifestyle changes, with regular follow-up appointments to monitor your progress 1.
From the Research
Definition and Causes of Hepatic Steatosis
- Hepatic steatosis is defined as intrahepatic fat of at least 5% of liver weight 2
- It is associated with obesity, type 2 diabetes, and dyslipidemia 2, 3
- The accumulation of intrahepatic fat is due to increased flux of fatty acids to the liver, increased de novo lipogenesis, and/or reduced clearance through β-oxidation or very-low-density lipoprotein secretion 2
First Line Treatment for Hepatic Steatosis
- Weight loss through diet and exercise is the primary treatment for non-alcoholic fatty liver disease (NAFLD) 3
- Other treatments, such as bariatric surgery, vitamin E supplements, and pharmacologic therapy with thiazolidinediones or glucagon-like peptide-1 analogues, have shown potential benefit but are not considered routine treatments 3, 4
- Pioglitazone and vitamin E have been shown to be effective in reducing steatosis, inflammation, and ballooning, and improving liver markers 5, 4
Treatment Options for Non-Alcoholic Steatohepatitis (NASH)
- Pioglitazone has been shown to be effective in reducing fibrosis and improving liver histology in patients with NASH 5, 4
- Vitamin E has been shown to be effective in reducing steatosis, inflammation, and ballooning, and improving liver markers in patients with NASH 5, 4
- Combination therapy with pioglitazone, exenatide, and metformin has been shown to reduce the prevalence of hepatic fibrosis and steatosis in patients with type 2 diabetes 6