Non-alcoholic fatty liver disease: What the clinician needs to know

Table 1 Summary of the management of non-alcoholic fatty liver disease

Lifestyle interventions - diet and physical exercise

Weight loss: 3%-5% if simple steatosis, 7%-10% if NASH

Accompanied by cognitive-behavior therapy program

Diet - hypocaloric, adjusted to the patients needs and body weight

Fat - prefer PUFAs, mainly ω3 - advise 2-3 oily fish meals/wk

≤ 25% as MUFA’s, avoid SAF (less than 7% total energy) Cholesterol ≤ 200 mg/d

Carbohydrates - ≥ 50% as whole grains, avoid high fructose corn syrup

No need to restrict coffee

Mild alcohol intake - do not prohibit, do not advise; recommend against in patients with cirrhosis

Exercise - aerobic and restrictive, ≥ 3-4 times/wk, ≥ 400 calories per session

Treat risk factors when present

Insulin sensitizers - no clear evidence to prefer thiazolidinediones or biguanides

Lipid-lowering drugs - statins are safe; protect from cardiovascular risk (more than in non-NAFLD)

Anti-hypertensive drugs - prefer ARAII if no contraindication, mainly telmisartan

Specific treatment for NAFLD

Consider vitamin E in patients with NASH, non-diabetic and without hypertension or at risk for prostate cancer

Pentoxifilin - promising agent that needs more evidence from large randomized clinical trials

Probiotics - promising agents that need more evidence from large randomized clinical trials

Screening for cancer

Screening for hepatocellular carcinoma every 6 mo in cirrhotic patients

Screening program (colorectal, breast, prostate and cervical cancer) as general population

NAFLD: Non-alcoholic fatty liver disease; NASH: Non-alcoholic steatohepatitis; PUFA: Polyunsaturated fatty acids; MUFA: Monounsaturated fatty acids; SAF: Saturated fatty acids; ARA II: Angiotensin II receptor antagonists.