Medicines for Non-alcoholic fatty liver disease

What it is

Non-alcoholic fatty liver disease (NAFLD, increasingly called metabolic dysfunction-associated liver disease) is a very common condition in which fat builds up in the liver in people who drink little or no alcohol. It is strongly linked to being overweight, type 2 diabetes, insulin resistance, high blood pressure, and abnormal cholesterol — the features of metabolic syndrome. In its early and most common form (simple fatty liver), it usually causes no symptoms and does not harm the liver, and is often found incidentally on a scan or when liver blood tests are mildly abnormal. However, in a proportion of people, the fat is accompanied by inflammation and liver cell damage (a more active form, sometimes called NASH), which can, over years, lead to scarring of the liver (fibrosis) and, in some, to advanced scarring (cirrhosis) and its complications, and an increased risk of liver cancer. People with NAFLD are also at higher risk of heart and blood vessel disease. Because it is common and usually silent, but can progress in some people, NAFLD is important to recognise and manage — and, encouragingly, it often improves with lifestyle changes.

How it is treated

The cornerstone of managing NAFLD is lifestyle change, which can reduce liver fat, calm inflammation, and even reverse early liver damage, as well as improving the associated metabolic and cardiovascular risks. Key measures include gradual weight loss where overweight (even a modest percentage of body weight can significantly reduce liver fat, and more can improve inflammation and scarring), a healthy diet (reducing sugary and highly processed foods and unhealthy fats), regular physical activity, limiting alcohol, and managing associated conditions — controlling diabetes, blood pressure and cholesterol — which both protect the liver and reduce heart-disease risk. Assessment includes liver blood tests and scans, and, importantly, tests to estimate the degree of any liver scarring (fibrosis), which is the main factor determining the outlook; those with, or at risk of, more significant scarring may be referred to a liver specialist for closer assessment and monitoring. There is no single specific medicine for NAFLD in routine use, so lifestyle change and managing risk factors are central, though this is an area of active research and some treatments are emerging. Ongoing monitoring tracks the liver over time. The reassuring message is that NAFLD is common and often improves substantially with weight loss and lifestyle change, which also protect the heart — and that assessing any liver scarring guides how closely it needs monitoring.