Early intervention in fatty liver disease is necesssary to prevent progression to inflammation, fibrosis, or cirrhosis. The cornerstone of management is lifestyle modification, supported by targeted therapies in selected cases.
Aim for a sustained loss of 15% of body weight, which can significantly reduce liver fat and inflammation.
A gradual weight loss of 0.5–1 kg per week is very essential
Adopt a Mediterranean-style diet rich in vegetables, fruits, whole grains, legumes, lean proteins (especially fish), and healthy fats (olive oil, nuts).
Minimize intake of refined carbohydrates (white bread, pastries), sugary beverages, and processed foods.
Limit saturated fat and trans fats found in red meat and fried foods.
Engage in at least 150 minutes per week of moderate-intensity aerobic exercise (e.g., brisk walking, cycling).
Incorporate resistance training (e.g., weight lifting) two to three times weekly to improve insulin sensitivity.
In nonalcoholic fatty liver disease (NAFLD), completely avoid or minimize alcohol consumption.
In alcoholic fatty liver disease (AFLD), total abstinence is mandatory.
Optimize glycemic control in diabetes with diet, exercise, and medications as needed.
Treat dyslipidemia with statins, which are safe in fatty liver and reduce cardiovascular risk.
Control hypertension through lifestyle and antihypertensive agents.
No medications are officially approved for NAFLD, but therapies may be considered in patients with biopsy-proven nonalcoholic steatohepatitis (NASH) and fibrosis.
Recommended in non-diabetic adults with biopsy‐confirmed NASH to reduce oxidative stress and improve liver histology.
A thiazolidinedione that improves insulin sensitivity and reduces liver inflammation; consider in patients with NASH and type 2 diabetes.
Routine Laboratory Tests: Liver enzymes (ALT, AST), fasting glucose, lipid panel every 6–12 months.
Transient elastography (FibroScan) or serum fibrosis panels (e.g., FIB-4 index) at baseline and periodically to gauge progression.
Imaging: Ultrasound or MRI-based techniques every 1–2 years if indicated.
For patients with morbid obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities) who fail lifestyle interventions, surgery can markedly improve steatosis and fibrosis.
Reserved for end-stage cirrhosis or hepatocellular carcinoma developing on fatty liver.
Sustainable weight loss through dietary modification and regular exercise remains the most effective approach to reverse fatty liver.