Nonalcoholic fatty liver disease, also known as nonalcoholic steatohepatitis, or NASH, is a chronic condition that affects 2 to 5 percent of people in the United States. Named to distinguish it from fatty liver disease that occurs in alcoholic patients, NASH involves inflammation or damage to the liver that can be severe and may lead to cirrhosis, liver failure, or liver cancer. The disease often goes hand in hand with diabetes. About 70 percent of people with type 2 diabetes have a fatty liver, according to a study published this month in Current Opinion in Endocrinology, Diabetes, and Obesity.
No specific medical therapies exist to treat nonalcoholic fatty liver disease, according to the National Digestive Diseases Information Clearinghouse. So doctors' advice on what patients should do after diagnosis and on how to prevent the condition may vary. Here are 5 tips from experts and recent studies for preventing and treating nonalcoholic fatty liver disease:
1. Lose weight,and exercise. Doctors often recommend weight loss as a first step for those newly diagnosed with fatty liver disease. The American Gastroenterological Association suggests weight loss of 10 percent or more for those with NASH.
A study published in January in the journal Hepatology demonstrates why. Researchers found that losing weight helped reverse nonalcoholic fatty liver disease. The small study of 50 patients found that a drug called orlistat (Xenical), which decreases the absorption of fat, did not seem to directly improve the condition of study participants' livers. But, the study suggests, weight loss can heal damage to the liver—if a person can shed a certain percentage of body weight. All participants committed to consuming a 1,400-calorie diet and vitamin E; half also took orlistat for 36 weeks. Whether they took orlistat or not, those participants who lost 5 percent or more of their body weight during the study were less insulin resistant and had less fat accumulate in the liver. Existing liver damage actually reversed in those who lost at least 9 percent of their body weight. This research "just adds to the accumulating scientific evidence that weight loss improves fatty liver disease," says study coauthor Brent Neuschwander-Tetri, professor of internal medicine at St. Louis University. So changing what you eat and starting a regular exercise routine are vital, he says.
2. Improve your diet, even if you're having trouble losing weight. You've heard the message time and time again: A healthful diet is considered key to a long and healthy life. But it may be especially important for those with nonalcoholic fatty liver disease. A 2007 study of mice found that diets heavy in so-called high-glycemic carbohydrates (such as white rice, white bread, concentrated sugar, and many prepared breakfast cereals), which get quickly digested, may lead to fatty liver disease. Mice on a high-glycemic diet received a kind of quickly digested cornstarch, while those eating a low-glycemic diet got a slowly digested cornstarch. After six months, the mice in the high-glycemic diet group had twice as much fat in their livers, blood, and bodies as the rest.
3. Consider a glass of wine. The prevailing advice for people with nonalcoholic fatty liver disease continues to be to avoid alcohol altogether. (After all, alcohol consumption can lead to a different type of fatty liver disease.) But a study published last year suggests an unconventional approach to preventing the condition. Researchers at the University of California-San Diego School of Medicine found that drinking a glass of wine a day may decrease the risk of nonalcoholic fatty liver disease. Study participants who reported drinking up to one glass of wine per day had their risk of liver disease cut in half, in comparison with those who drank no alcohol. But that doesn't apply to all types of alcohol: People who said they regularly drank up to 12 ounces of beer or 1 ounce of liquor had more than four times the odds of ending up with NASH, according to the study, published in June 2008 in Hepatology.
4. Don't count on experimental treatments. While some studies suggest that experimental treatments such as taking vitamins C and E could combat fatty liver disease, others show contradictory findings. At this point, data are too limited to support the use of those vitamins in patients with nonalcoholic fatty liver disease. Other still-experimental therapies include selenium and a nutrient called betaine; they act by limiting oxidative stress that seems to increase in the livers of patients with nonalcoholic fatty liver disease. Clinical trials are underway to flesh out whether such therapies are beneficial.
The use of newer diabetes medicines—metformin (sold under the brand names Fortamet, Glucophage, Glumetza, and Riomet), rosiglitazone (Avandia), and pioglitazone (Actos)—to treat fatty liver disease is also considered experimental, except in patients who are also diabetic. (And there has been some concern over data that suggest that Avandia may raise heart-attack risk.) Because most people who have fatty liver are also insulin resistant, it's thought that taking the diabetes medicines may increase the body's sensitivity to insulin and help limit injury to the liver. Studies sponsored by the National Institutes of Health are in progress to determine whether there's any merit to this idea.
5. Get other medical conditions treated. It's not uncommon for people with nonalcoholic fatty liver disease to have other medical problems, such as diabetes, hypertension, or high cholesterol. People with fatty liver should follow their doctors' recommendations for medications and control of these conditions.
