SAN FRANCISCO — With no specific treatment available for nonalcoholic fatty liver disease, the best current strategy centers on monitoring the patient's condition and managing the patient's lifestyle and metabolic syndrome, Dr. Nathan M. Bass said at the Third World Congress on Insulin Resistance Syndrome.
The patient's liver enzymes, liver function (bilirubin levels, albumin levels, prothrombin time), and platelet count should be monitored. Each patient also should undergo regular ultrasound exams. Patients should be instructed to avoid hepatotoxins—most notably, alcohol—and should be advised to pursue gradual weight loss with diet and exercise.
“Weight loss remains the simplest advice you can give,” said Dr. Bass of the University of California, San Francisco, citing a study showing even modest weight loss (less than 10% of initial body weight) can reduce intrahepatic fat while leaving intramuscular fat unchanged. Such weight loss also improved basal and insulin-stimulated glucose metabolism (Diabetes 2005;54:603–8).
Bariatric surgery can be helpful for some patients with nonalcoholic fatty liver disease (NAFLD), but it should be the newer restrictive surgery involving gastric banding, which tends to decrease steatosis, fibrosis, and nonalcoholic steatohepatitis. Older malabsorptive surgical strategies can be dangerous; they can lead to increased steatosis, fibrosis, nonalcoholic steatohepatitis, and liver failure. The insulin-sensitizing agent metformin appears to be helpful in NAFLD; but the published studies tend to be small and open label, so the evidence base is not overwhelming. The thiazolidinediones pioglitazone and troglitazone seem to improve liver enzymes and fibrosis measured histologically, but again, the evidence is from open-label trials.
Dr. Bass noted some caveats with thiazolidinediones: They can cause weight gain and relapse upon discontinuation, and some patients experience serious side effects such as congestive heart failure and hepatotoxicity.