Treatment for fatty liver

The most effective treatment for fatty liver disease (NAFLD) is lifestyle modification focusing on diet and exercise, aiming for gradual sustained weight loss, especially in overweight or obese individuals. A target weight loss of 5-10% over 6 months with a calorie deficit of approximately 600 kcal/day is recommended. Combining aerobic exercise with dietary changes, such as adopting a Mediterranean diet, is the most effective approach to reduce liver fat and improve liver health. Moderate intensity exercise totaling 150-200 minutes per week in 3-5 sessions is advised. Alcohol consumption should be kept within national recommended limits to reduce liver disease risk. Management of associated metabolic conditions like hypertension, hyperlipidaemia, and type 2 diabetes is also important. Currently, no specific drug treatment is licensed for NAFLD in primary care, but in secondary or tertiary care, off-label use of pioglitazone or vitamin E may be considered for adults with advanced liver fibrosis. Bariatric surgery is an option for eligible patients and has shown significant resolution of steatosis and fibrosis. Statins are safe and beneficial for people with NAFLD who require them for cardiovascular risk management and may improve liver histology.

Summary:

• Lifestyle modification with diet and aerobic exercise is first-line and most effective treatment ¹,².
• Weight loss of 5-10% over 6 months with calorie deficit is recommended ¹.
• Mediterranean diet and avoidance of sugary drinks are beneficial ¹.
• Exercise of moderate intensity for 150-200 minutes weekly is advised ¹.
• Alcohol intake should be within recommended limits ¹.
• Manage comorbidities such as diabetes, hypertension, and hyperlipidaemia ¹.
• Pioglitazone and vitamin E may be used off-label in secondary care for advanced fibrosis ¹,².
• Bariatric surgery can resolve steatosis and fibrosis in selected patients ¹.
• Statins are safe and may improve liver outcomes in NAFLD ¹.