From the Guidelines
Lifestyle modification using diet and exercise to achieve weight loss is the most beneficial approach for treating nonalcoholic fatty liver disease (NAFLD), with a goal of losing 5-10% of total body weight. This approach has been shown to decrease hepatic steatosis, lead to nonalcoholic steatohepatitis resolution, and result in fibrosis regression or stability 1. The Mediterranean diet is recommended, with a focus on minimizing saturated fatty acid intake and limiting or eliminating consumption of commercially produced fructose 1. Regular physical activity, such as 150-300 minutes of moderate-intensity aerobic exercise per week, is also recommended, as it can enhance the positive effect of a hypocaloric diet on NAFLD 1.
Key components of the treatment plan include:
- Weight loss of 5-10% through a balanced diet and regular exercise
- Reducing consumption of processed foods, sugary beverages, and saturated fats
- Increasing intake of fruits, vegetables, whole grains, and lean proteins
- Avoiding alcohol completely
- Good glycemic control for patients with diabetes
- Regular follow-up with healthcare providers to monitor liver function and disease progression
It is essential to note that while medications such as vitamin E and pioglitazone may be beneficial for some patients with NAFLD, lifestyle modifications remain the cornerstone of treatment 1. Additionally, patients with NAFLD should be evaluated for coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, and these comorbidities should be managed aggressively 1.
From the Research
Treatment Options for NAFLD
- Lifestyle modifications such as weight loss, a Mediterranean diet, and physical activity are considered essential for treating NAFLD 2, 3, 4, 5, 6
- Pharmacological treatment options include Vitamin E and Pioglitazone, as well as emerging therapies such as GLP-1 agonists, FXR and PPAR ligands 2
- Other potential therapeutic agents include statins, peroxisome proliferator‑activated receptor agonists, cenicriviroc, and farnesoid X receptor agonists 4
- Biologically active substances such as peptides, alkaloids, polyphenolic compounds, silymarin, antibiotics, fatty acids, vitamins, probiotics, synbiotics, and lamiaceae may also have beneficial effects on NAFLD 4
Management Strategies
- Careful risk stratification is necessary to determine the best course of treatment for patients with NAFLD 6
- Management strategies should focus on lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high-risk patients, and managing the complications of cirrhosis 6
- Combination treatment may be required for many patients with NAFLD due to the complex pathophysiology and substantial heterogeneity of disease phenotypes 5