Prevention and Treatment of Fatty Liver Disease
Update Date：2025/01/06，
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Dr. Huang Wei-Chen and Dr. Chuang Der-Rong from the Gastroenterology Division
What is Fatty Liver Disease?
Fatty liver disease refers to the accumulation of excessive fat droplets (triglycerides) in liver cells. When the fat content in the liver exceeds 5%, it is medically termed as steatotic liver disease. In the past, to distinguish it from alcohol-induced fatty liver disease, the more common form of fatty liver was referred to as "non-alcoholic fatty liver disease" (NAFLD). However, the European Association for the Study of the Liver (EASL) has updated its guidelines and now uses the term "metabolic dysfunction-associated steatotic liver disease" (MASLD) to replace "non-alcoholic fatty liver disease." This change reflects the similar pathophysiological mechanisms between fatty liver and metabolic diseases such as obesity, diabetes, and cardiovascular diseases.
The diagnostic criteria include liver fat accumulation along with at least one of the five cardiovascular risk factors: overweight/obesity, hypertension, two lipid abnormalities, or diabetes.
Is Fatty Liver Disease Related to Me?
Globally, approximately 25-30% of the population is affected by metabolic dysfunction-associated steatotic liver disease (MASLD), with the prevalence of metabolic-associated steatohepatitis (MASH) ranging from 3-5%. The risk of progressing to cirrhosis is approximately 1-2%. In Taiwan, according to a nationwide free abdominal ultrasound screening conducted by the Liver Disease Prevention and Treatment Academic Foundation in 2023, it was found that one in every two people has fatty liver, with the prevalence rate being higher than the global average.
Is Fatty Liver Disease Dangerous?
Increasing research evidence suggests that patients with fatty liver disease are at risk of developing metabolic-associated steatohepatitis (MASH), and they have a higher lifetime risk of progressing to cirrhosis compared to the general population, which can ultimately lead to liver cancer. Beyond liver damage, fatty liver disease is closely linked to hypertension, diabetes, obesity, cancer, chronic kidney disease, and other metabolic abnormalities.
Statistics show that individuals with fatty liver disease have a 1.4-fold higher risk of cardiovascular diseases, a 1.75-fold higher risk of hypertension, a 2.56-fold higher risk of diabetes, and a 1.54-fold higher risk of cancer. Among these, the risk of liver cancer is particularly high, with a 4.37-fold increased risk. In other words, fatty liver disease is not only the beginning of the "liver cancer trilogy" (hepatitis -> cirrhosis -> liver cancer), but also an "early warning indicator" for various metabolic diseases, increasing the risk of multiple cancers and accelerating cardiovascular disease.
How to Screen, Diagnose, and Monitor Fatty Liver Disease?
Although blood tests cannot directly diagnose fatty liver disease, they help assess liver function and determine if inflammation is present in the liver. The main method for diagnosing fatty liver is typically imaging, with abdominal ultrasound being the most common approach. This can provide an initial evaluation of fat accumulation or fibrosis in the liver. Additionally, computed tomography (CT) and magnetic resonance imaging (MRI) are alternative methods for assessment.
Liver biopsy is the invasive method for confirming a fatty liver diagnosis, while a liver stiffness measurement using a fibrosis scanner is a non-invasive approach that quantifies the degree of fatty liver or liver fibrosis by measuring the liver's stiffness based on differences in echo wave speed.
For patients diagnosed with fatty liver disease, regular follow-up visits are recommended for blood tests (including liver enzyme levels and alpha-fetoprotein) and abdominal ultrasound monitoring.
Fatty Liver Disease Treatment
The first approach to treating fatty liver disease is typically non-pharmacological treatment.
Diet: The principle is to follow a low-calorie, low-carbohydrate, and low-fat diet. The Mediterranean diet, in particular, has been shown to help reduce both fatty liver and cardiovascular diseases. Additionally, studies on animals have found that drinking coffee (around three cups daily) can reduce the risk of fatty liver by about 10%. It is also recommended to limit processed foods and sugary drinks.
Exercise: At least 150 minutes of moderate-intensity exercise per week, or at least 75 minutes of vigorous-intensity exercise, is advised.
Weight Control: Maintaining a healthy weight is critical. Research has shown that reducing body weight by 5% can improve fatty liver. A weight loss of 7-10% can help improve fatty liver disease, while significant improvement in liver fibrosis requires at least a 10% reduction in body weight.
For pharmacological treatment, historically, there have been no approved drugs to treat metabolic-associated steatohepatitis (MASH). However, in March 2024, the U.S. Food and Drug Administration (FDA) approved an oral medication called Rezdiffra (resmetirom) for fatty liver. Rezdiffra is a partial thyroid hormone receptor agonist that activates this receptor in the liver to reduce fat accumulation. It is intended for adults with moderate to severe liver fibrosis associated with metabolic fatty liver disease and is currently the only drug that helps improve liver inflammation and fibrosis. However, this drug has not been approved in Taiwan.
In addition, treatment for other comorbid conditions (e.g., diabetes, dyslipidemia, or obesity) may be prescribed, such as subcutaneous weight loss injections, insulin, glucose-lowering drugs, or lipid-lowering medications.
Conclusion
Metabolic-associated steatotic liver disease (MASLD) has become an increasingly serious global health issue. Due to its subtle early symptoms, MASLD can lead to multiple complications such as liver cirrhosis, cardiovascular diseases, and cancer. Therefore, screening, early diagnosis, and disease monitoring for fatty liver are especially important. Lifestyle changes, including dietary adjustments, exercise, and weight loss, have been proven to improve the condition. With the continuous development of new medications, more treatment options will become available for patients in the future. Regular follow-up in the gastroenterology outpatient clinic, in collaboration with metabolic specialists, dietitians, and health educators, is essential for the effective care of fatty liver disease.
References
1. New England Journal of Medicine. 2020 July 23;383(4):369-378
2. European Journal of Medicine 2024;122:3-10