COMMENTARY

Fatty Liver Takes Center Stage

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 04, 2013

In This Article

Treatment: It's Mainly Weight Loss

Several speakers reviewed the various medical and surgical approaches to the management of the patient with fatty liver disease. In the absence of proven efficacy for pharmacologic treatment, the emphasis was on lifestyle alterations. The American Association for the Study of Liver Disease (AASLD) guidelines for NASH management recommend that patients lose 10% of their body weight, because this has been shown to correlate with histologic improvement in steatosis, inflammation, and NAFLD activity score.[16]

The effect of weight loss on hepatic fibrosis, however, is less well understood. A study presented here[17] of patients with NASH who underwent serial biopsies over a 10-year period was conducted to monitor disease progression. Univariate analyses revealed a higher rate of fibrosis regression in patients who lost more than 10% of their body weight. Regression of fibrosis, a key disease endpoint, gives strong support for the AASLD weight loss guidelines.

Another study[18] documented the effect of weight loss on quantitative changes in liver fat in patients with biopsy-proven NAFLD. They used a novel imaging biomarker based on MRI assessment of the fat fraction. Weight loss with > 5% reduction in body mass index led to a significant reduction in both liver and pancreatic fat. This method may be of value in clinical use and in NASH treatment trials.

Finally, a long-term goal in managing and monitoring patients with fatty liver disease is to avoid major complications such as hepatocellular carcinoma. At this meeting, investigators[19] reported the inhibitory effects of a statin on inflammation and tumor formation in a strain of mice with fatty liver disease that developed hepatocellular carcinoma when fed a high-fat diet. This drug may inhibit cancer formation by its anti-inflammatory effect as well as the inhibitory effect on lipids synthesis, which raises the possibility that statin administration may prove to be a beneficial adjunctive approach for patients with fatty liver disease who are at risk for hepatocellular carcinoma.

The bottom line is that the information presented here offered new insights into mechanisms of fatty liver disease and perhaps some new directions for diagnosis and management. What is missing, of course, is a reliable and effective treatment approach. This emphasizes the important role of prevention of hepatic steatosis. We must promote healthy eating and consistent physical activity to forestall obesity and its complications.

Thank you for listening. This is Bill Balistreri for Medscape.

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