Steatotic liver disease can be treated

DEAR DR. ROACH >> 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,” aka fatty liver disease. My labs were all normal, including an ALT test of 19.

Could you please discuss nonalcoholic fatty liver disease?

The word “fatty” carries a stigma, so the names have

DEAR READER >>

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 may lead to liver fibrosis and even cirrhosis.

Steatotic liver disease is increasingly prevalent in recent years. 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.

Treatment of MASLD, even in people without MASH, includes avoiding alcohol. Most people with MASLD are overweight, and even in people whose weight is in the average range benefit from weight loss of 5% to 7%. For most people, weight loss is the primary therapy.

The specific diet is less important than the actual weight loss, but I want to be clear here that crash or fad diets 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.

Drug therapy to help a person lose weight can be considered in people who would benefit from weight loss but who have not been able to accomplish this with lifestyle changes alone.