What are the American Association for the Study of Liver Diseases (AASLD) treatment guidelines for non-alcoholic fatty liver disease (NAFLD)?

Updated: Apr 12, 2018
  • Author: Emily Tommolino, MD; Chief Editor: BS Anand, MD  more...
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The 2018 practice guidelines from the American Association for the Study of Liver Diseases (AASLD) include the following recommendations regarding treatment of NAFLD [89] :

  • Weight loss of 3%-5% of body weight generally reduces hepatic steatosis, but up to 10% weight loss may be needed to improve necroinflammation.

  • A combination of reduced calorie diet and moderate intensity exercise may aid in sustaining weight loss, along with aggressive modification of cardiovascular risk factors.
  • Patients with NAFLD should not consume heavy amounts of alcohol; data are insufficient to make recommendations with regard to nonheavy alcohol consumption.

  • Pharmacologic treatments should be limited to individuals with biopsy-proven NASH and fibrosis.
  • Vitamin E 800 IU/day improves liver histology in nondiabetic adults with biopsy-proven NASH; it should therefore be considered as a first-line pharmacotherapy for this patient population, and the risks and benefits should be discussed with the patient prior to starting treatment.

  • Omega-3 fatty acids may be considered for hypertriglyceridemia in patients with NAFLD, but it is premature to recommend them for the specific treatment of NAFLD or NASH.

  • Metformin is not recommended as a specific treatment for liver disease in adults with NASH.

  • Pioglitazone may be used to treat steatohepatitis in both patients with and without type 2 diabetes with biopsy-proven NASH, but the risks and benefits should be thoroughly discussed with the patient prior to initiation of treatment.

  • Glucagon-like peptide (GLP)-1 agonists have been studied to treat liver disease in patients with NAFLD or NASH; however, it is still premature to consider these agents as treatment options at this time.
  • Foregut bariatric surgery is not contraindicated in otherwise eligible obese individuals with NAFLD or NASH but without established cirrhosis; however, it is premature to consider foregut bariatric surgery as an established option to treat NASH specifically.

  • Ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) are not recommended to treat NASH or NAFLD.
  • Statins can be used to treat dyslipidemia in patients with NAFLD and NASH, but they should not be used specifically to treat NASH, pending evidence from randomized controlled trials. Statins should be avoided in patients with decompensated cirrhosis.

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