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Weight loss remains the only known treatment for NAFLD
By: Scottsdale Weight Loss Center
Published: January 24, 2019
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Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. It can be divided into 2 types. Non-alcoholic fatty liver (NAFL) is characterized by isolated steatosis. Non-alcoholic Steatohepatitis (NASH) is more aggressive and is characterized by cell injury, inflammation, ballooning of the hepatocyte and may lead to fibrosis, cirrhosis, and hepatocellular carcinoma. At the root of NAFLD is an unhealthy lifestyle and obesity. Weight loss is the only known treatment at present. Interventions that include both dietary restriction and exercise to specifically achieve 5-10% weight loss seem consistently effective at improving NAFLD. As little as 3% weight loss may help reduce hepatic steatosis but the greatest beneficial effects on fibrosis and portal inflammation were observed in patients achieving >10% weight loss. Weight loss via bariatric surgery has clearly shown improvement in steatosis, steatoheptatitis and fibrosis or even complete resolution of NAFLD.
Moderate dietary restriction and 30-60 min of moderate-intensity exercise on 3-5 days per week is generally recommended. Dietary intervention trials alone have shown reductions in body weight lead to significant improvements in liver histology. Most trials used low calorie ranges from 1200-2000 kcal/day. Trials that used very low calorie ranges between 400-800 kcal/day showed greater weight loss, clear improvement in histology, and in some cases complete resolution of NAFLD. VLCD interventions require medical supervision and there is risk of weight regain. A low carbohydrate diet may arguably improve NAFLD more so than other forms of dietary restriction. Low carbohydrate intake is defined as 50-150g of carbohydrate per day. Very low carbohydrate intake is <50g per day.
Exercise alone may improve steatosis but liver histology does not clearly improve. Again, it is weight loss that matters. Moderate-intensity exercise requires effort. A patient should experience increased heart rate, increased rate of breathing without feeling short of breath and a light sweat. A good rule of them is that they should be able to hold a conversation while exercising but not be able to sing.
While there are many pharmaco-therapeutic options in NASH – insulin sensitizers, antioxidants, cytoprotective and lipids lowering agents – none are FDA-approved at present. No specific therapy is firmly recommended and current drug treatment is considered off-label. Drugs such as vitamin E and pioglitazone show conflicting results. They may help carefully selected patients but neither has shown consistently reliable effects on fibrosis. Whatever the outcome of the myriad clinical trials, none of the medications under investigation are expected to make a significant impact on NASH for the majority of patients.
Lifestyle changes are mandatory in all patients with NAFLD. Weight loss can reverse NAFLD/NASH. A lower calorie (1200-1500 kcal/day), lower carbohydrate intake (50-150 g/day) with exercise that causes a light sweat and an increased rate of breathing should always be a first line recommendation. If they can achieve at least 3% of weight loss then they are on the right path. The reality is that weight loss is easier said than done — very few can achieve and sustain a 5% let alone 10% weight loss especially on their own. Patients with more risk factors, more advanced disease and more weight to lose need more intense and sustained weight loss. If patients are not reaching their goals, they need to get additional help.
Nick
Nick's Story
"I wish I would have come here first. We spend all our time reacting to the next great weight loss tip or program. It might work for a while, but does not last and we end up yo-yoing from one fad to the next – as we gain more weight." Read More
Gina
Lost 44.5 lbs
"I had no trouble adhering to the meals and they really helped catapult my progress! The classes were so beneficial to me because they helped change my thinking about how I viewed health, nutrition, and fitness.
I will always have my relationship with Scottsdale Weight Loss Center. They truly helped me change my life forever." Read More
Lauren
Lost 60 lbs
"Dr. Ziltzer and everyone who I have come in contact with at the Scottsdale Weight Loss office have been so encouraging and I look forward to seeing them each week. It is now a year and 2 months later since I started. I am down 60 lbs., which is the average amount a 9-year-old weighs, it is crazy to think I lost a whole person! I feel amazing, I hit my goal weight in November 2021 just before Thanksgiving. Nothing on my body hurts anymore..." Read More
Chuck
Lost 66 lbs
"The best thing I did was call the Scottsdale Weight Loss Center. I have a lot more energy, I'm not hungry, and it feels great.
You can take it from me that this is a program that produces results. The staff is always positive, supportive, and never judgmental.
Your visits always result in positive reinforcement, no matter if you had a good week or a bad week." Read More
Emily
Lost 101 lbs
"Here I am at the lowest I have been since high school weighing in at 155lbs. I have lost 101 lbs, BMI of 39 when I started, to 21.6, and of course at body fat % of 47.1 to 26.5%. I told myself by my 30th birthday I wanted to be confident in the way I look and I owe it all to SWLC. The entire staff is so welcoming and they are rooting for you just as much as you are rooting for yourself...." Read More
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Meet Our Team
Robert Ziltzer, MD, FACP, FAAP, FOMA
Obesity Medicine Certified Physician
Diana Bone, FNP-C
Specializing in Obesity Medicine
Craig Primack, MD, FACP, FAAP, MFOMA
Obesity Medicine Certified Physician
Kristen Ash, FNP-C, FNP-BC
Nurse Practitioner
Alicia Earley, FNP-C
Family Nurse Practitioner
