From the Guidelines
The primary approach to managing fatty liver disease should involve lifestyle modifications, including a hypocaloric diet and regular exercise, aiming for a weight loss of 5-10% of total body weight, as this has been shown to decrease hepatic steatosis, resolve nonalcoholic steatohepatitis, and regress or stabilize fibrosis 1.
Key Components of Lifestyle Modifications
- Adopting a Mediterranean-style diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, while minimizing saturated fatty acid intake and limiting or eliminating consumption of commercially produced fructose 1.
- Implementing a hypocaloric diet targeting 1200-1500 kcal/d or a reduction of 500-1000 kcal/d from baseline, with a lower target weight-loss threshold of 3-5% for non-Asian patients with a body mass index of 24 kg/m² and for Asian patients with a body mass index of 26 kg/m² 1.
- Engaging in regular physical activity, with a target of 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week, and considering resistance training exercise as a complementary approach 1.
Additional Recommendations
- Restricting or eliminating alcohol consumption, as even low alcohol intake has been associated with increased risks for advanced liver disease and cancer in individuals with NAFLD 1.
- Managing coexisting metabolic conditions, such as obesity, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease, aggressively, and using medications like statins and glucose-lowering medications as recommended by current guidelines 1.
- Considering the use of glucagon-like peptide 1 receptor agonists (GLP-1RAs), sodium-glucose co-transporter-2 (SGLT2) inhibitors, and pioglitazone in individuals with type 2 diabetes and NAFLD, based on current American Diabetes Association guidelines 1.
From the Research
Plan of Care for Fatty Liver
The plan of care for fatty liver, also known as nonalcoholic fatty liver disease (NAFLD), involves a combination of lifestyle modifications and potential pharmacological interventions.
- Lifestyle modifications are the primary approach to treatment, with a focus on weight loss, dietary changes, and increased physical activity 2, 3.
- A hypocaloric diet to induce weight loss and subsequent improvement in liver enzymes and histology is recommended, as well as a Mediterranean diet, which can lead to improvement in steatosis even in the absence of weight reduction 3.
- Patients should aim to lose at least 7% to 10% of body weight via a combination of physical exercise and calorie restriction dieting 2.
- Surgical or endoscopic surgery for weight loss can be considered in obese patients, depending on degree of excess body weight and comorbidities 2.
Pharmacological Interventions
While there are no currently approved pharmacotherapies for NAFLD, several agents have shown promise in improving liver function and histology.
- Vitamin E has been shown to have a beneficial effect on NAFLD, with significant reductions in liver enzymes and improvement in histologic changes 4.
- Pioglitazone has also shown significant histological benefit in several trials, but its use is limited by concerns over side effects, such as weight gain 2, 5, 6.
- Other antidiabetic agents, such as metformin, glucagon-like peptide-1 analogues, and sodium-dependent glucose cotransporter inhibitors, have shown benefits in improving metabolic parameters and reducing hepatic lipid accumulation and inflammation, but their role in specifically reversing NAFLD needs to be established 6.
- Statins have been shown to reduce the risk of cardiovascular morbidity and mortality in patients with NAFLD and dyslipidemia, but their use specifically for treatment of NAFLD needs further evaluation 6.