From the Guidelines
High grade fatty liver disease, now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), necessitates a multifaceted approach to manage the condition effectively and prevent progression to more severe liver diseases, with a focus on lifestyle modification and optimal management of comorbidities. The management of MASLD involves a stepwise approach to rule out advanced fibrosis, which is predictive of liver-related outcomes, using non-invasive tests such as blood-based scores (e.g., the fibrosis-4 index [FIB-4]) and imaging techniques (e.g., transient elastography) 1.
Key components of the management plan include:
- Lifestyle modification: weight loss, dietary changes (limiting processed foods, sugars, and saturated fats, and increasing consumption of vegetables, fruits, whole grains, and lean proteins), physical exercise, and discouraging alcohol consumption.
- Optimal management of comorbidities: use of incretin-based therapies (e.g., semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated.
- Consideration of bariatric surgery in individuals with MASLD and obesity.
- For adults with non-cirrhotic MASH and significant liver fibrosis (stage ≥2), consideration of a MASH-targeted treatment with resmetirom, if locally approved and dependent on the label, due to its demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1.
It is crucial to manage associated conditions like diabetes, hypertension, and high cholesterol, and to conduct regular monitoring with liver function tests to track improvement. These interventions are aimed at reducing fat accumulation in the liver, decreasing insulin resistance, and lowering inflammation, thereby preventing the progression of high grade fatty liver to more severe conditions such as steatohepatitis, fibrosis, cirrhosis, and liver failure.
From the Research
High Grade Fatty Liver Treatment Options
- Lifestyle modifications, including exercise, are considered first-line treatment for nonalcoholic fatty liver disease (NAFLD) 2, 3
- Exercise has been shown to reduce liver fat and improve liver function in patients with NAFLD 2
- Vitamin E has been found to have a beneficial effect on NAFLD, improving liver function and histological changes in patients with the disease 4, 5
Vitamin E as a Treatment Option
- Vitamin E has been shown to reduce aspartate transaminase (AST) and alanine aminotransferase (ALT) levels in patients with NAFLD 4, 5
- Vitamin E has also been found to improve histological features of NAFLD, including steatosis, inflammation, and hepatocellular ballooning 4, 5
- However, vitamin E does not seem to have significant effects on liver fibrosis 5
Other Treatment Options
- Metformin has been studied as a potential treatment for NAFLD, but its effectiveness is still unclear 6
- Lifestyle modifications, including diet and exercise, are still considered the most effective treatment for NAFLD 2, 3