There is now evidence to suggest that nonalcoholic fatty liver disease is quickly becoming the most common reason of chronic liver disease, and this is especially important news for patients with obesity and their treating physicians and health care teams.

The increase in the number of patients with obesity is behind the uptick in cases of nonalcoholic fatty liver disease (NAFLD). There is now evidence to suggest that nonalcoholic fatty liver disease is quickly becoming the most common reason of chronic liver disease,¹ and this is especially important news for patients with obesity and their treating physicians and health care teams.

Roughly 20-30 percent of adults in the United States are believed to be affected by NAFLD² and experts anticipate it will surpass other causes for liver transplants. While not every patient with NAFLD will need a transplant, there are still health risks that warrant its detection and treatment to mitigate associated health risks. Because there are no FDA-approved treatments, lifestyle changes such as diet modification and increased physical activity designed for weight loss are the primary interventions.

Nonalcoholic Fatty Liver Disease

Like all disease states, nonalcoholic fatty liver disease exists on a continuum. On the less severe end of the continuum, patients may develop simple steatosis that can evolve into nonalcoholic steatohepatitis (NASH). Nonalcoholic steatohepatitis is characterized by inflammation and ballooning of the lobes, and left undiagnosed and untreated, NASH can be fatal.¹ Nonalcoholic fatty liver disease can progress from fibrosis to cirrhosis, though it should be noted that fibrosis is more common in NASH than simple steatosis.¹

While the pathophysiology of NASH is still being investigated, it is believed that there are multiple mechanisms and pathways implicated in the pathogenesis of NASH. ¹ The recognized mechanisms of NASH include diet and insulin resistance. Insulin resistance can be affected by lifestyle changes such weight loss driven by dietary changes and physical activity.

Nonalcoholic Fatty Liver Disease and Lifestyle Changes

Because there is currently no FDA approved drug for treating nonalcoholic fatty liver disease², any pharmacological therapies would be considered off-label. To mitigate risk of off-label usage, physicians should consider working with patients to implement sustainable dietary changes and increased physical activity to optimize the chance of sustained weight loss. As reported in a 2018 study¹, a five percent reduction in weight improved hepatic steatosis and weight loss of more than seven percent improved nonalcoholic steatohepatitis.

A prospective 2015 study³ (N = 216) investigated the effects of lifestyle modifications for weight loss. In this study, participants livers were biopsied pre and post lifestyle modification and results. Fibrosis regression and NASH resolution was observed in patients with weight loss > 10 percent. Additional support comes from a study⁴ that examined the role of increased physical activity. In this study, improvements in hepatic steatosis were observed in patients who exercised for > 150 minutes per week. In patients who increased their exercise by 60 minutes per week, a decrease in serum aminotransferases was observed.

Lifestyle Changes are Critical for Managing NAFLD

Given the relationship between diet, exercise, and nonalcoholic fatty liver disease, it is important to include lifestyle changes as the first steps in treating NAFLD. Health care providers should work with patients with obesity that are at risk for NAFLD to create a sustainable plan for weight loss. Diet modifications such as shifting patients with obesity to a Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD) can jumpstart weight loss and mitigate the risk of developing NAFLD. Because of their nutritional value, medically prescribed meal replacements should be considered as part of any shift to an LCD or VLCD. In addition to dietary modifications, health care providers should work with patients to develop exercise programs that are tailored to and sustainable for their patients’ needs. Until an FDA-approved pharmacological intervention is approved, and even afterwards, lifestyle changes can efficaciously mitigate the risk of NAFLD.

Sources:

1 Obesity and nonalcoholic fatty liver disease: Current perspectives

2 What are the current pharmacological therapies for nonalcoholic fatty liver disease?

3 Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis

4 Independent effects of physical activity in patients with nonalcoholic fatty liver disease