Lifestyle modification with dietary restriction and regular exercise is the first
choice of treatment for NAFLD. It is generally recommended that patients with
NAFLD lose 10% of their body weight in a gradual fashion, but this goal is
difficult to achieve.
If resources are available, a multidisciplinary approach with
behavioral therapy, dietary advice, and monitoring by a professional nutritionist
and an exercise expert is more successful than a prescriptive approach.
Statins (e.g., atorvastatin 20 mg daily) with or without vitamins C and E can
improve liver test results and reduce subsequent NAFLD.
In a large trial,800 IU of vitamin E administered daily for 2 years significantly improved liver histology.
Thiazolidinedione insulin sensitizers (pioglitazone and rosiglitazone)
improve steatosis, inflammation, and ballooning, but may not improve
fibrosis. 8 Unfortunately, the weight gain that is common with thiazolidinediones
may offset the histologic benefits that they offer. In morbidly obese individuals
with NASH and other significant metabolic comorbidities, foregut
bariatric surgery can lead to significant improvement in hepatic histology, but
the physician must exclude the presence of portal hypertension before offering
this type of surgery. 9 Patients with NAFLD often have dyslipidemia that
puts them at excessive risk for coronary artery disease; their dyslipidemia
(Chapter 213) should be treated aggressively with statins and other lipidlowering
agents, which can be safely administered to patients with NAFLD and
NASH. Carefully selected patients with decompensated cirrhosis owing to
NASH can be treated with liver transplantation (Chapter 157), but recurrence
during the post-transplantation period is common.
TREATMENT
PREVENTION