From the Guidelines
Management of fatty liver primarily involves lifestyle modifications, with weight loss being the cornerstone of treatment, aiming for a gradual weight reduction of 7-10% of body weight through a combination of caloric restriction and regular exercise, as recommended by the most recent guidelines 1. The goal of treatment is to reduce liver fat, inflammation, and fibrosis, thereby preventing progression to more severe liver conditions like cirrhosis.
- Key components of lifestyle modification include:
- Dietary changes: A Mediterranean diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats is recommended, while limiting processed foods, sugary beverages, and alcohol 1.
- Physical activity: Regular physical activity of at least 150 minutes per week of moderate-intensity exercise helps improve insulin sensitivity and reduce liver fat 1.
- Weight loss: Aiming for a weight loss of 5% of total body weight can decrease hepatic steatosis, while a weight loss of 7% can lead to nonalcoholic steatohepatitis resolution, and a weight loss of 10% can result in fibrosis regression or stability 1.
- Additional considerations include:
- Management of comorbidities: Optimal management of comorbidities, such as type 2 diabetes, obesity, and cardiovascular disease, is crucial in patients with fatty liver disease 1.
- Pharmacotherapy: While no medications are specifically FDA-approved for fatty liver, certain medications like vitamin E and pioglitazone may be considered in specific patient populations 1.
- Monitoring: Regular monitoring of liver enzymes and periodic imaging is important to track disease progression and adjust treatment as needed 1.
From the Research
Management of Fatty Liver
The management of fatty liver, also known as non-alcoholic fatty liver disease (NAFLD), involves lifestyle modifications as the primary intervention.
- Weight loss through increased physical activity and dietary changes is recommended to ameliorate biochemical, histological, and structural abnormalities of NAFLD 2, 3.
- A combination of dietary modifications and increased physical activity remains the mainstay of NAFLD management, with significant long-term benefits 3.
- Increased physical activity has therapeutic effects on NAFLD by reducing hepatic fat independent of weight reduction, and even minimal physical activity may have a beneficial impact on NAFLD 4.
Lifestyle Modifications
Lifestyle modifications, including:
- Dietary changes: a healthy diet is essential in the management of NAFLD, with some studies suggesting that a combination of diet and exercise is superior to either intervention alone 5.
- Physical activity: aerobic activity and resistance training have similar effects on NAFLD, and physical activity should be tailored based on a patient's clinical characteristics, comorbidities, and fitness capacity 4.
- Weight loss: a 7 to 10% reduction in weight improves steatosis, inflammation, hepatocyte ballooning, and fibrosis in patients with NAFLD 5.
Effectiveness of Lifestyle Changes
Lifestyle changes have been shown to be effective in the treatment of NAFLD, with combined exercise and diet resulting in greater reductions in liver enzymes and HOMA-IR compared to diet or exercise alone 5.
- Exercise also improves quality of life, cardiorespiratory fitness, and weight in patients with NAFLD 5.
- Intervening in patients' unhealthy lifestyles, such as weight loss through dietary changes and exercises, can reduce the severity of the disease, improve the quality of life, and increase the survival expectancy of patients with NAFLD 6.