Treatment for Fatty Infiltration of the Liver
Your liver cells normally contain a small amount of stored fat.
Nonalcoholic fatty liver disease (NAFLD) describes abnormal accumulation of fat in liver cells
not caused by excessive alcohol consumption or another liver condition, such hepatitis
B or C.
The two types of NAFLD include nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis
(NASH).
These conditions differ in that there is no inflammation or liver cell damage with NAFL
but both are present with NASH.
Risk factors for NAFLD include type 2 diabetes, prediabetes, high blood pressure, overweight
or obesity, and abnormal blood fat levels.
Treatment centers primarily on lifestyle modification to improve underlying risk factors to reduce
the likelihood of developing liver scarring and cirrhosis.
Weight Reduction
Weight reduction is a cornerstone of NAFLD treatment.
A pooled analysis of 8 studies published in April 2012 in the journal Diabetologia reported
that just a 7 percent reduction in body weight resulted in decreased liver cell fat and liver
disease improvement.
The authors noted that improvements increased in parallel with the percentage of weight
reduction.
Reducing your caloric intake helps with NAFLD because it mobilizes the stored fat in your
liver cells.
In addition to liver disease improvements, weight reduction in these studies was associated
with improvements in markers for heart disease risk, such as levels of blood fats.
This is important because people with NAFLD are at increased risk for heart disease.
Approach
According to January 2018 practice guidance from the American Association for the Study
of Liver Diseases (AASLD), there is insufficient evidence to recommend a specific weight-reduction
diet for the treatment of NAFLD.
However, the guidance states that data suggest decreasing caloric intake by at least 30 percent
or by approximately 750 to 1,000 calories daily results in reduced liver cell fat.
Physical Activity
The AASLD guidance for NAFLD management states that the combination of a reduced-calorie
diet and moderate-intensity exercise provides the greatest opportunity for sustained weight
reduction.
This is likely because exercise helps increase your metabolic rate and burns calories.
There is also some evidence that excercise might reduce liver cell fat even with minimal
to no associated weight loss, as reported in a July 2012 Journal of Hepatology article.
Medications and Supplements
Pioglitazone
As of January 2018, AASLD guidance includes only one prescription medication for consideration
to specifically treat NASH.
Pioglitazone (Actos) was developed as a type 2 diabetes medication but has been shown to
improve liver inflammation and other indicators of liver damage in people with NASH.
AASLD states this medication may be used to treat biopsy-proven NASH in people with or
without type 2 diabetes after a discussion of potential risks and benefits.
Potential risks include weight gain and bone loss in women.
AASLD does not currently recommend pioglitazone for people with NAFL.
Vitamin E
An excess of free radicals -- chemicals that can lead to cellular injury when present in
abnormally high concentrations -- is thought to contribute to liver damage in people with
NASH.
Vitamin E is a potent antioxidant, a substance that neutralizes free radicals.
Other Considerations
As people with NAFLD usually have other health challenges and face an increased risk for
heart disease, the comprehensive medical treatment plan often includes other therapies.
This might include medications for diabetes, high blood pressure and/or blood fat abnormalities,
depending on individual circumstances.
Additionally, research is ongoing and treatment recommendations for NAFLD are likely to change
as new research data become available.
If you have any questions or concerns, talk with your healthcare provider.
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