Management of Non-Alcoholic Fatty Liver Disease (NAFLD)

Lifestyle Modifications and Pharmacologic Interventions

The American Association for the Study of Liver Diseases recommends lifestyle modifications, including weight loss and exercise, as the cornerstone of therapy for NAFLD, with a target weight loss of 7-10% to improve steatohepatitis and achieve fibrosis regression 1, 2, 4
A Mediterranean diet with daily vegetables, fruits, fiber-rich cereals, nuts, fish or white meat, and olive oil is recommended for patients with NAFLD 7, 5, 6
The American Heart Association recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity exercise weekly for patients with NAFLD 5, 6
Vitamin E (800 IU/day) improves steatohepatitis in non-diabetic patients with biopsy-proven NASH, though long-term safety concerns exist, according to the American Association for the Study of Liver Diseases 1, 2
Pioglitazone (30-45 mg/day) benefits select patients with biopsy-proven NASH but causes weight gain and has limited fibrosis improvement data, as stated by the American Diabetes Association 1, 2, 6

The American Association for the Study of Liver Diseases recommends hepatocellular carcinoma surveillance every 6 months with ultrasound for patients with advanced fibrosis or cirrhosis, as NASH cirrhosis carries 2-3% annual HCC incidence 3, 5
Esophagogastroduodenoscopy screening for varices is recommended at diagnosis if cirrhosis is present or if liver stiffness ≥20 kPa, according to the American Gastroenterological Association 3, 5

Statins are safe and strongly recommended in compensated cirrhosis (Child A-B), reducing hepatic decompensation by 46% and mortality by 46%, as stated by the American College of Cardiology 5, 6
GLP-1 receptor agonists are preferred for diabetes control given potential liver benefits, according to the American Diabetes Association 5
Complete alcohol abstinence is mandatory, as even low intake doubles adverse liver outcomes, as recommended by the National Institute on Alcohol Abuse and Alcoholism 6