Fatty liver disease is a growing problem in the United States, but there's no single effective treatment approach. There's also no cure for it. As a first line of defense, your doctor may advise that you attempt to lose weight through lifestyle changes involving diet and exercise. Weight loss and good nutrition improve some of the features of nonalcoholic fatty liver disease, or NAFLD, which is frequently accompanied by obesity and insulin resistance. If your own efforts to lose weight don't work, your doctor may also advise weight-loss surgery to improve or possibly reverse NAFLD.
Nonalcoholic Fatty Liver Disease
Up to 25 percent of American adults suffer from NAFLD, and another 5 percent have its more advanced counterpart, nonalcoholic steatohepatitis, or NASH. Fatty liver disease is an umbrella term referring to a range of conditions involving the accumulation of fat cells in the liver. According to the American Liver Foundation, NAFLD is diagnosed through a liver biopsy and is usually marked by having more than 5 to 10 percent of your liver's weight comprised of fat cells. Your liver is your body's chemical factory and is composed of several different populations of cells. A growth in fat cells can cause injury to the liver leading up to cirrhosis, liver failure and increased risk of liver cancer. Insulin resistance, which is a frequent companion to obesity, is strongly implicated in the development of NAFLD, so weight loss is a primary treatment method.
Weight Loss as Treatment of NAFLD
The American Gastroenterology Association, or AGA, recommends that overweight and obese patients with NAFLD lose 7 to 10 percent of their body weight through modifications to their eating and physical activity over a period of six to 12 months. The guidance is based on studies the association has published showing that weight loss of this magnitude improves insulin resistance and other structures of the disease. In addition, weight loss can help reduce the fat buildup as well as the release of proteins and enzymes that trigger the inflammation response to an injured liver. The National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK, also says a "major attempt" should be made to reduce body weight into a healthy range for people with more advanced fatty liver conditions. It says weight loss may "reverse the disease to some extent."
Diet Tweaks
The AGA and the NIDDK say that although several research projects have investigated whether NAFLD patients should eat proteins, fats and carbs in specific proportions, strong enough evidence doesn't exist yet to make these recommendations. The AGA says people with NAFLD should eat low-glycemic foods and reduce their intake of saturated and trans fats. They should increase their intake of mono- and polyunsaturated fats. The organization, buoyed by findings reported in the March 2010 "Digestive Diseases and Sciences," urges you not to consume high amounts of fructose if you have NAFLD.
Bariatric Surgery
Public health officials recognize the difficulty of losing weight. For those who are obese and have been unable to lose weight despite stepped-up efforts under the care of a physician, bariatric surgery is an alternative means to produce the weight loss needed to improve NAFLD. Bariatric surgery, specifically that involving gastric banding, significantly reduces injurious enzymes, fat buildup, inflammation and fibrosis among obese patients with NAFLD. In a July 2005 "Obesity" study of 16 patients undergoing Roux-en-Y form of bariatric surgery, the majority of patients experienced these improvements and no patient experienced a progression of the disease, which is common among those who don't get treatment. The patients lost an average of 118 pounds.
References
- "Hepatology"; Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: Selected Practical Issues in Their Evaluation and Management; Raj Vuppalanchi and Naga Chalasani; January 2009
- "Digestive Diseases and Sciences"; Nonalcoholic Fatty Liver Disease: A Review and Update; Jeffrey R. Lewis and Smruti R. Mohanty; March 2010
- "Journal of Clinical Gastroenterology"; Weight Loss as a Treatment for Nonalcoholic Fatty Liver Disease; Jeanne M. Clarke; March 2006
- "Journal of Clinical Gastroenterology"; Effect of Weight Loss on Nonalcoholic Fatty Liver Disease; Anish A. Patel et al.; November/December 2009
- "U.S. News & World Report"; Nonalcoholic Fatty Liver Disease: 5 Tips for Treatment, Prevention; January Payne; April 10, 2009
- "Obesity"; Roux-en-Y Gastric Bypass Improves Liver Histology in Patients with Non-Alcoholic Fatty Liver Disease; Jeanne M. Clark et al.; July 2005
