Non-alcoholic fatty liver disease

How can non-alcoholic fatty liver disease be treated?

Encourage people with non-alcoholic fatty liver disease (NAFLD) to make lifestyle changes. In particular they should increase physical activity and try to lose weight, both of which have been shown to improve liver histology1 and reduce cardiovascular risk. Explain that minimising alcohol intake prevents further liver damage.2 

In mild disease, when the patient has steatosis (fatty liver) without inflammation, there is no need for drug therapy.2 Treat blood glucose and lipid levels according to usual practice, particularly if they have more serious disease in which both fatty liver and inflammation are present (non-alcoholic steatohepatitis or NASH).2,3

Currently, there are no drugs that are accepted treatment for NAFLD2 and no evidence that any drug can prevent progression to diabetes, liver disease or cardiovascular disease in people with NAFLD. There are trials of metformin and the thiazolidinediones in people with NAFLD but most had methodological concerns that make interpretation difficult. Most trials followed participants for less than a year and provided little or no information on long-term patient outcomes, instead relying on short-term surrogate outcomes to measure efficacy instead (e.g. change in ALT levels).4 Pioglitazone significantly improved ALT levels compared to placebo but increased weight. Metformin did not significantly improve ALT levels in most trials against placebo. However, people taking metformin lost weight.4

1. Musso G, et al. Hepatology 2010;52:79-104.

2. Digestive Health Foundation. Fatty Liver Disease. Sydney: Gastroenterological Society of Australia, 2007

3. Gastrointestinal Writing Group. Therapeutic Guidelines: Gastrointestinal, Version 5 [eTG complete CD-ROM]. 2011

4. Shyangdan D, et al. Health technology assessment 2011;15:1-110.