Summary of management of NAFLD
| Treatment | Intervention/indication | Target/outcome |
|---|---|---|
| Diet | Calorie 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 | ||
| Exercise | Increasing physical activity | Lower levels of steatosis14 |
| Reduce total sedentary time | Aerobic exercise improves insulin sensitivity15 16 | |
| 30 min moderate exercise 5×/week | Improved 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/m211 | Improves ALT and steatosis13 |
| Only continue if >5% loss of body weight in 3 months is achieved | ||
| Bariatric surgery | Not a primary treatment for NASH | Improve insulin sensitivity and lipid profile |
| Treatment for obesity if BMI >40 kg/m2 or between 35 and 40 kg/m2 with other significant disease11 | Reduced steatosis, steatohepatitis and fibrosis19 | |
| Consider as first-line option if BMI greater >50 kg/m211 | Gastric bypass procedures are most effective in producing sustained weight loss20 | |
| Pioglitazone | Recommended for patients with more aggressive NASH who have failed lifestyle interventions | Reduces hepatocellular injury and fibrosis21–23 |
| Consider increased risk of congestive cardiac failure, bladder cancer and reduced bone density | ||
| Vitamin E | Reserved for selected patients with more advanced precirrhotic NASH who have failed lifestyle interventions | Improves steatohepatitis22 24 |
ALT, alanine transaminase; BMI, body index mass; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis.