There is no specific treatment for NAFLD that all doctors agree on.
However, there is good evidence that gradual weight loss coupled with increased exercise can reduce the amount of fat in your liver.
In mild cases of fatty liver, most doctors will concentrate on treating conditions such as obesity and diabetes that can cause fat to build up. They will also treat disorders such as high blood pressure and high cholesterol that often go along with fatty liver.
If your NAFLD is linked to being overweight, then you will be advised to lose weight gradually and take sensible exercise. If it is linked to diabetes, high blood pressure or high cholesterol then you will need to watch your diet and your weight, and may also need to take medication.
What are the long term effects?
What will happen largely depends on what stage of NAFLD you have. Most people will have fatty liver (steatosis) and should not have any long-term ill effects.
Very few people will go on to develop NASH which, in a small number of cases, can lead to cirrhosis. Unfortunately, there is no reliable way to predict who will develop these serious latter stages of NAFLD.
For this reason, if you have been diagnosed with a fatty liver, most doctors recommend some form of monitoring (usually a blood test every six months or so) to make sure the condition is not getting worse.
If you do go on to develop NASH over a ten year period you have a one in five (20%) chance of developing cirrhosis and a little less than a one in ten (10%) chance of dying from a liver-related problem.
Cirrhosis is not in itself fatal. However, when it develops it does signify a high risk of liver cancer or liver failure, both of which are potentially fatal. A liver with cirrhosis rarely (if ever) returns to normal. However, the risk of further damage can be reduced enormously if the disease which caused the cirrhosis is treated.
However, if cirrhosis has become so severe that your liver may fail completely, a liver transplant may be the only option.
A liver transplant is usually only recommended if other treatments are no longer helpful and your life is threatened by end stage liver disease. It is a major operation and you will need to plan it carefully with your medical team, family and friends.
After a successful transplant a person can make a full recovery and lead a normal active life.
However, they must be checked regularly and it is not known whether fatty liver may develop in the new organ.
Treatments under investigation
There are no specific medications available for the prevention and treatment of NAFLD but a number of areas are being explored, principally drugs that reduce appetite, lower blood fats and increase insulin sensitivity. Many of these drugs have been developed to treat other conditions.
These include statins, a class of drug used to treat cardiovascular disease. Statins decrease the production of cholesterol and it is thought that this may have a benefit in treating NASH. In the past there have been concerns about the use of statins in patients with liver disease but it is now clear that patients with fatty liver disease and NASH can take these drugs as safely as any other patients.
As the majority of patients with NASH have insulin resistance, it is thought new medications that make the body more sensitive to insulin may help reduce liver damage in people with NASH – even if they do not have diabetes.
Ursodeoxycholic acid (URSO), a drug used to reduce the production of bile acids, is being looked at as a way of bringing down the liver enzyme levels associated with inflammation.
Dietary supplements too, are being evaluated. These include the role of fat-soluble antioxidants, such as vitamin E. Antioxidants are considered helpful in reducing levels of bad cholesterol (LDL) in the arteries.
Omega-3 fatty acids, extracted from fish oil, may be effective in decreasing triglycerides and raising HDL.
Clinical trials
Doctors are always trying to find better ways of treating people. Medical staff may talk to you about the possibility of taking part in a clinical trial. This may involve treatment with new drugs or new ways of using drugs.
You do not have to take part in clinical trials and your care will not be affected if you do not. If you do take part, you may receive extra monitoring which may be beneficial to your treatment. The doctor involved in the research will give you specific information about any clinical trials.