Table 1

Summary of management of NAFLD

DietCalorie restricted diet (600 calories less than daily requirement)>7%12 and ≥9%13 loss of body weight reduces steatosis, ballooning and hepatic inflammation
Aim to lose 0.5–1.0 kg/week11
Avoid saturated fats, simple carbohydrates and sweetened drinks
Aim to lose >10% body weight and maintain loss
ExerciseIncreasing physical activityLower levels of steatosis14
Reduce total sedentary timeAerobic exercise improves insulin sensitivity15 16
30 min moderate exercise 5×/weekImproved liver enzymes and reduced liver fat17 18
‘Aerobic’, ‘resistance’ and ‘high intensity’ exercise are all effective
Aim >10 000 steps/day (pedometer)
Orlistat (enteric lipase inhibitor)Achieve weight loss in conjunction with lifestyle modification if BMI>30 kg/m211Improves ALT and steatosis13
Only continue if >5% loss of body weight in 3 months is achieved
Bariatric surgeryNot a primary treatment for NASHImprove insulin sensitivity and lipid profile
Treatment for obesity if BMI >40 kg/m2 or between 35 and 40 kg/m2 with other significant disease11Reduced steatosis, steatohepatitis and fibrosis19
Consider as first-line option if BMI greater >50 kg/m211Gastric bypass procedures are most effective in producing sustained weight loss20
PioglitazoneRecommended for patients with more aggressive NASH who have failed lifestyle interventionsReduces hepatocellular injury and fibrosis21–23
Consider increased risk of congestive cardiac failure, bladder cancer and reduced bone density
Vitamin EReserved for selected patients with more advanced precirrhotic NASH who have failed lifestyle interventionsImproves steatohepatitis22 24
  • ALT, alanine transaminase; BMI, body index mass; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis.