for Health Care Providers
Treatment - Non-Alcoholic Fatty Liver
How can we treat non-alcoholic fatty liver?
- Intensive lifestyle intervention with ≥7% weight loss diminishes liver inflammation; ≥10% weight loss decreasing liver fibrosis. Motivational interviewing to engage patient to create their preferred plan, cognitive behavioral therapy, weight loss, diet, and exercise provide the most enduring benefit.
- As adjuncts to intensive lifestyle intervention,
- weight loss pharmacotherapy can achieve 3-9% weight loss
- bariatric surgery (up to 20-30% weight loss) may be considered if BMI≥40 kg/m2 or >35 with comorbidity (e.g., diabetes, HTN6)
- With elevated ALT (for >6 months) or increased fibrosis prediction score (e.g. FIB-4), non-alcoholic steatohepatitis is more frequent and merits hepatology/GI referral for consideration of FibroScan or liver biopsy.
- No NAFL pharmacotherapy is currently licensed.
The Diagnosis and Management of Non-Alcoholic Fatty Liver Disease
Practice Guidance from the American Association for the Study of Liver Diseases; Hepatology, 2018