Treatment for Fatty Liver

Treatment

1. Treatment of Alcoholic Fatty Liver

1. Lifestyle Improvement Therapy

Alcoholic fatty liver develops due to excessive drinking, so treatment begins with giving up alcohol and ends with giving up alcohol.

In particular, fatty liver, which is an early stage of liver damage caused by alcohol, can return to normal if alcohol is stopped, so it is best to quit as soon as possible. As with smoking, it is easy to start abstaining from alcohol, but very difficult to continue.

There is no safe standard for drinking, but as mentioned above, up to two bottles of soju per week for men and up to one bottle of soju for women is appropriate, and it is important not to drink alcohol for at least 2 to 3 days after one drinking session (a rest period). In addition, because liver damage caused by alcohol becomes worse in a state of nutritional deficiency, it is also important not to skip meals. If it is difficult for an individual to stop drinking on their own, it is better to visit a hospital to check their health condition and receive psychiatric treatment, or to get help from an abstinence support group or a professional counselor.

2. Drug Therapy

In addition to stopping or reducing alcohol, antioxidants (vitamin E, vitamin B, C) are used as treatment. There are also reports that hepatocyte-protective agents such as ursodeoxycholic acid or silymarin are effective.

2. Treatment of Non-Alcoholic Fatty Liver

1. Lifestyle Improvement Therapy

70 to 80% of patients with fatty liver disease are obese, and many others are known to be overweight. Weight loss improves insulin sensitivity and helps fatty liver improve. The goal is to lose about 10% of the current body weight over 6 months. For exercise therapy, moderate-intensity exercise is recommended at least 3 times a week for about 60 to 90 minutes per session. As for diet therapy, foods with low nutritional value (fried foods, greasy foods, etc.) should be avoided as much as possible, and in the case of mild obesity (body mass index between 25 and 29.9), reduce daily intake by 500 kcal; in moderate obesity (between 30 and 34.5), reduce food intake by 500 to 1,000 kcal to try to lose about 0.5 kg per week.

However, excessive weight loss in a short period of time through very low-calorie diets can increase intrahepatic inflammation and should be avoided.

Recently, there have been reports that even a reduction of about 5% of body weight improves insulin resistance and liver function test values, so even if the amount is relatively small, efforts should still be made to lose weight. Since the food consumption pattern of patients with fatty liver is almost the same as that of healthy people, the proportions of carbohydrates, protein, and fat are not thought to be important.

Recently, there was a study showing that administration of omega-3 fatty acids improved liver function test values in patients with fatty liver accompanied by hypertriglyceridemia. However, commercially available omega-3 products differ in purity and ingredients depending on the manufacturer during production, making it difficult to determine therapeutic doses, and their effectiveness is not yet certain. For patients who have limitations with diet or exercise therapy, or for those with severe obesity, weight loss can be aided with medication.

2. Surgical Treatment

In the past, patients with severe obesity who were candidates for bariatric surgery were very rare in Korea, but recently the number has gradually increased. Bariatric surgery is recommended for severe obesity or when the body mass index is > 35 kg/㎡ and risk factors such as diabetes or hypertension are present.

Bariatric surgical procedures include: 1) procedures that induce early satiety to reduce food intake, 2) procedures that induce malabsorption by bypassing the small intestine, and 3) procedures that achieve the effects of both. Improvement in liver function test values and reduction of intrahepatic fat after bariatric surgery have been reported in most cases, but the results regarding improvement in inflammation and fibrosis are inconsistent. Among studies to date, procedures that reduce food intake by inducing early satiety are known to be relatively safe in patients with fatty liver.

3. Drug Therapy

(1) Diabetes medications and drugs that improve insulin resistance

All medications for type 2 (adult-onset) diabetes are thought to be effective. Among them, insulin injections and ordinary oral diabetes medications that stimulate insulin secretion, such as the sulfonylurea class, are less effective because of their mechanism of action related to insulin secretion, while metformin and the more recently developed thiazolidinediones are known to be effective because they suppress glucose production in the liver and improve insulin sensitivity.

(2) Antioxidants and hepatocyte-protective agents

The use of antioxidants is being studied to reduce oxidative stress, one of the mechanisms involved in the development of fatty liver disease, and vitamin E is known to have some effect on liver function test values and even on histological examination. Various drugs that are precursor substances of glutathione, a naturally occurring antioxidant in the liver, can be used to treat fatty liver through antioxidant action that increases hepatic glutathione.

(3) Lipid-lowering drugs

Coronary artery disease caused by hyperlipidemia is the most common cause of death in patients with non-alcoholic fatty liver disease, so the use of lipid-lowering drugs may be considered for treatment in patients with non-alcoholic fatty liver disease accompanied by hyperlipidemia.

Drugs such as statins may have the potential to cause liver toxicity, but because significant liver toxicity is rare in patients with steatohepatitis, they can be used relatively safely.

(4) Future Outlook

Fatty liver disease is relatively mild at the time of diagnosis and may gradually worsen over a long period of time, so the choice of medication should be one that does not cause side effects even with short-term or long-term use. Therefore, the development or discovery of medications requires relatively more time and effort than for other diseases. Even up to now, the mechanisms of onset of fatty liver disease have not been clearly identified, and there is an abundance of drugs said to help fatty liver disease. Therefore, after consulting a liver specialist, it is important to choose the treatment that is right for you. In the future, new drugs will emerge according to newly discovered disease mechanisms, so the outlook for fatty liver treatment can be said to be bright.

So far, I have explained treatment for fatty liver.

In the next part, we will look at childhood obesity.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal