Nonalcoholic fatty liver disease: treatment

Park, Sang Hoon

Abstract

Recently, nonalcoholic fatty liver disease (NAFLD) is highly prevalent even in Korea, which has the potential to progress to cryptogenic cirrhosis and hepatocellular carcinoma. It is not only regarded as a hepatic component of the metabolic syndrome but also as an independent risk factor and a marker for increase in cardiovascular disease. We should keep in mind the NAFLD is a "treatable and have to treat" disease to prevent early death from liver and cardiovascular complications. Weight loss via lifestyle modification remains the most common and fundamental therapy advocated for reducing hepatic lipid in NAFLD. There is increasing evidence that exercise or physical activity beneficially modulates liver fat independent of weight loss. Although reduced total calorie intake potentially plays a role in the treatment of NAFLD, dietary macronutrient composition may also play a role. Low-carbohydrate and low-fructose diets are of particular benefit to reduce steatosis and improve biochemical tests. Polyunsaturated fatty acid (n3-PUFA) and monounsaturated fatty acid (MUFA) may play a protective role against increase liver fat. Limitation of Saturated fat and trans-fatty acids intake is very recommendable. Even lifestyle modifications continued to be the cornerstone of therapy in NAFLD, some insulin-sensitizing drug may be a more effective means in the treatment of NAFLD. Vitamin E and statins have demonstrated promising initial results in improving liver enzymes or features of liver histology. Bariatric surgery is very useful treatment option for morbidly obese NAFLD patients. However, weight loss medication is not recommended which have shown varying degrees of side effects for the treatment of NAFLD.