Nonalcoholic Fatty Liver Disease and Obesity Treatment

Abstract

Purpose of review: Nonalcoholic fatty liver disease (NAFLD), the most prevalent cause of chronic liver disease worldwide, is strongly associated with obesity and insulin resistance.

Recent findings: Significant weight loss can improve NAFLD and nonalcoholic steatohepatitis (NASH). Diet and exercise that result in a sustained body weight reduction of 7-10% can improve liver fat content, NASH, and fibrosis. Vitamin E can be considered in patients with biopsy-proven NASH without diabetes, though caution must be used in those with prostate cancer. Pioglitazone improves liver histology, including fibrosis, and can be considered in patients with or without diabetes. Glucagon-like peptide-1 (GLP-1) antagonists may be beneficial in NASH, but more studies are needed before they can be recommended. Bariatric surgery, with resultant weight loss, can result in improvement in liver fat and inflammation. NAFLD treatment includes diet and exercise with a target 7-10% weight reduction. Treatment goals include improvements in liver fat content, liver inflammation, and fibrosis.

Keywords: Bariatric surgery; Body mass index; Diabetes; Intrahepatic triglycerides; Magnetic resonance elastography; NAFLD activity score; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Obesity.

Fig. 1

Treatment algorithm for nonalcoholic fatty liver disease. This treatment algorithm shows a practical approach to be used clinically to identify patients at highest risk for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and fibrosis. AST, aspartate aminotransferase; ALT, alanine aminotransferase; ANA, anti-nuclear antibody, ASMA, anti-smooth muscle antibody; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; MRE, magnetic resonance elastography; APRI, AST to platelet ratio index; FIB-4, fibrosis-4 index for liver fibrosis