Steatotic liver disease treated with weight loss, exercise
I had right upper abdominal pain, and my doctor suspected gallbladder problems. The abdominal ultrasound showed that my gallbladder was normal, and the HIDA scan showed normal gallbladder function. But the ultrasound reported “hepatic steatosis,” a.k.a. fatty liver disease. My labs were all normal, including an ALT test of 19.
My doctor did not seem concerned and had little to offer. I’ve gleaned what information I can from the internet.
Could you please discuss nonalcoholic fatty liver disease? It seems to be exceedingly common, but rarely mentioned. I’d be particularly interested in any dietary or supplemental recommendations.
Anon.
The word “fatty” carries a stigma, so the names have changed. Nonalcoholic fatty liver disease, now called steatotic liver disease, is a spectrum of illness — from the more-benign metabolic dysfunction-associated steatotic liver disease (MASLD) to metabolic dysfunction-associated steatohepatitis (MASH). The difference between the two is liver inflammation that might lead to liver fibrosis and even cirrhosis, which is the end stage of liver disease.
Steatotic liver disease is increasingly prevalent in recent years, with studies showing diagnoses in 30 to 46 per cent of people in the United States and 25 per cent in Canada. Risk factors include obesity, especially central obesity; diabetes; high cholesterol; and high blood pressure. Although liver tests like the ALT are often elevated, they do not always have to be to receive a diagnosis. Most people are in their 40s and 50s at the time of diagnosis. The diagnosis is usually made by ultrasound, but a biopsy is advised in some cases.
Treatment of MASLD, even in people without MASH, includes avoiding alcohol. Heavy alcohol use makes the disease progress, but even occasional use might also be harmful. So, it is best to avoid it. Most people with MASLD are overweight, and even in people whose weight is in the average range (specifically people with a BMI above 25) benefit from weight loss of five to seven per cent. For most people, weight loss is the primary therapy.
The specific diet is less important than the weight loss, but I want to be clear that crash or fad diets, which cause shortterm weight loss that includes a lot of “water weight” or muscle loss, are not healthy and rarely lead to sustained weight loss. Working with a registered dietician can help ensure a good diet, and I strongly recommend a regular moderate exercise program as well.
Supplements are not part of therapy for most people with MASLD. Vitamin E is used for some people who have MASH but don’t have diabetes; this decision requires careful consideration and consultation with an expert. Vitamin E has not been proven effective in people with diabetes, and it has been shown in one large trial to increase prostate cancer risk. It should not be used in a person at very high risk of or with a history of prostate cancer.
Drug therapy to help a person lose weight, such as semaglutide, can be considered in people who would benefit from weight loss but who have not been able to accomplish this with lifestyle changes alone.