Your liver cells normally contain a small amount of stored fat. Nonalcoholic fatty liver disease (NAFLD) describes abnormal accumulation of fat in liver cells not caused by excessive alcohol consumption or another liver condition, such hepatitis B or C. The two types of NAFLD include nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). These conditions differ in that there is no inflammation or liver cell damage with NAFL but both are present with NASH. Risk factors for NAFLD include type 2 diabetes, prediabetes, high blood pressure, overweight or obesity, and abnormal blood fat levels. Treatment centers primarily on lifestyle modification to improve underlying risk factors to reduce the likelihood of developing liver scarring and cirrhosis.
Weight reduction is a cornerstone of NAFLD treatment. A pooled analysis of 8 studies published in April 2012 in the journal Diabetologia reported that just a 7 percent reduction in body weight resulted in decreased liver cell fat and liver disease improvement. The authors noted that improvements increased in parallel with the percentage of weight reduction. Reducing your caloric intake helps with NAFLD because it mobilizes the stored fat in your liver cells. In addition to liver disease improvements, weight reduction in these studies was associated with improvements in markers for heart disease risk, such as levels of blood fats. This is important because people with NAFLD are at increased risk for heart disease.
According to January 2018 practice guidance from the American Association for the Study of Liver Diseases (AASLD), there is insufficient evidence to recommend a specific weight-reduction diet for the treatment of NAFLD. However, the guidance states that data suggest decreasing caloric intake by at least 30 percent or by approximately 750 to 1,000 calories daily results in reduced liver cell fat. The guidance further states that weight-loss surgery is a consideration for eligible candidates struggling with obesity and NAFLD without cirrhosis.
The AASLD guidance for NAFLD management states that the combination of a reduced-calorie diet and moderate-intensity exercise provides the greatest opportunity for sustained weight reduction. This is likely because exercise helps increase your metabolic rate and burns calories. There is also some evidence that excercise might reduce liver cell fat even with minimal to no associated weight loss, as reported in a July 2012 Journal of Hepatology article. The researchers based their conclusion on a pooled analysis of 6 studies. AASLD recommends diet and exercise counseling for all patients with NAFLD.
Medications and Supplements
As of January 2018, AASLD guidance includes only one prescription medication for consideration to specifically treat NASH. Pioglitazone (Actos) was developed as a type 2 diabetes medication but has been shown to improve liver inflammation and other indicators of liver damage in people with NASH. AASLD states this medication may be used to treat biopsy-proven NASH in people with or without type 2 diabetes after a discussion of potential risks and benefits. Potential risks include weight gain and bone loss in women. AASLD does not currently recommend pioglitazone for people with NAFL.
An excess of free radicals -- chemicals that can lead to cellular injury when present in abnormally high concentrations -- is thought to contribute to liver damage in people with NASH. Vitamin E is a potent antioxidant, a substance that neutralizes free radicals. Based on results from several studies, the AASLD guidance for NAFLD management states that 800 IU of vitamin E daily is a consideration for people without diabetes or cirrhosis who have biopsy-proven NASH. AASLD does not currently recommend vitamin E supplementation for people with NASH who have diabetes and/or cirrhosis, or for people with NAFL.
As people with NAFLD usually have other health challenges and face an increased risk for heart disease, the comprehensive medical treatment plan often includes other therapies. This might include medications for diabetes, high blood pressure and/or blood fat abnormalities, depending on individual circumstances. Additionally, research is ongoing and treatment recommendations for NAFLD are likely to change as new research data become available. If you have any questions or concerns, talk with your healthcare provider.
Is This an Emergency?
- Hepatology: The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases
- NICE Guidelines: Non-Alcoholic Fatty Liver Disease: Assessment and Management
- International Journal of Molecular Sciences: Definitions of Normal Liver Fat and the Association of Insulin Sensitivity with Acquired and Genetic NAFLD—A Systematic Review
- Diabetologia: Impact of Current Treatments on Liver Disease, Glucose Metabolism and Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease (Nafld): a Systematic Review and Meta-Analysis of Randomised Trials
- Journal of Hepatology: Exercise and Non-Alcoholic Fatty Liver Disease: a Systematic Review and Meta-Analysis
- Hepatology: Independent Effects of Physical Activity in Patients With Nonalcoholic Fatty Liver Disease