From the Guidelines
Alcoholic fatty liver disease requires immediate and complete abstinence from alcohol to prevent progression to more severe liver damage, as supported by the most recent guidelines from 2024 1. To manage this condition, it is essential to stop alcohol consumption entirely, as even moderate drinking can exacerbate liver damage. The amount, pattern, and history of alcohol intake should be documented in all individuals with liver disease, and those with moderate or high alcohol intake should be discouraged from consuming alcohol 1.
Key Components of Treatment
- Complete abstinence from alcohol
- Healthy diet low in processed foods and sugar
- Regular exercise, aiming for 150 minutes of moderate activity weekly
- Maintaining a healthy weight
- Vitamin supplements, particularly B-complex vitamins, to address nutritional deficiencies
Addressing Alcohol Dependence
For individuals struggling with alcohol dependence, seeking support through counseling, support groups like Alcoholics Anonymous, or medications such as naltrexone, acamprosate, or disulfiram prescribed by a healthcare provider can help maintain sobriety 2.
Monitoring and Follow-up
Regular medical follow-up is crucial to monitor liver function and ensure recovery is progressing appropriately. This includes assessing the stage of liver disease, as the liver-related mortality rate at five years is significantly higher in patients with advanced disease 2.
Lifestyle Interventions
Lifestyle interventions, such as promoting weight loss in overweight or obese patients, educating patients about nutritional strategies, regular physical activity, and avoiding excess alcohol intake, are also essential components of treatment 3. A Mediterranean diet, which is rich in vegetables, fresh fruit, and olive oil, and low in simple sugars and red meat, has been associated with improved insulin sensitivity and lower mortality 3.
Pharmacologic Treatment
While specific pharmacologic treatment targeting liver steatosis is not necessary for patients with low-risk fatty liver disease, medications such as statins, glucagon-like peptide 1 receptor agonists (GLP-1RAs), and sodium-glucose co-transporter-2 (SGLT2) inhibitors may be beneficial in managing cardiovascular risk factors and improving the cardiometabolic profile 3.
From the Research
Fatty Liver Disease
Fatty liver disease can be caused by excessive alcohol consumption, known as alcoholic fatty liver disease, or by non-alcoholic factors, known as non-alcoholic fatty liver disease (NAFLD) 4.
Causes and Risk Factors
- Excessive alcohol consumption is a major risk factor for alcoholic fatty liver disease 5.
- Non-alcoholic fatty liver disease is commonly associated with insulin resistance, obesity, dyslipidaemia, type 2 diabetes mellitus, and cardiovascular disease 6, 7.
- Insulin resistance is an almost universal finding in nonalcoholic fatty liver disease (NAFLD) and is characterized by reductions in whole-body, hepatic, and adipose tissue insulin sensitivity 8.
Treatment Options
- The treatment for alcoholic liver disease remains abstinence, nutritional support, and corticosteroids (or pentoxifylline as an alternative if steroids are contraindicated) 4, 5.
- For non-alcoholic fatty liver disease, the treatment modality is mainly directed toward weight loss and co-morbidity management 4, 6.
- Vitamin E and the thiazolidinedione pioglitazone have shown the most consistent results in randomized controlled trials for the treatment of NAFLD 6, 7.
Diagnosis and Prognosis
- The diagnosis of nonalcoholic steatohepatitis (NASH) is challenging, as most affected patients are symptom-free, and a liver biopsy is often required for a definitive diagnosis 7.
- Alcohol-associated liver disease is the primary cause of liver-related mortality and the leading indication for liver transplant, representing 40% to 50% of all liver transplants in high-income countries 5.
- Ten-year survival of patients with alcohol-associated liver disease is 88% among those who are abstinent and 73% for those who relapse to alcohol consumption 5.