Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease which is also associated with several metabolic comorbidities. Apart from damaging the liver, NAFLD is also associated with higher rates of cardiovascular mortalities. Immediate intervention following diagnosis will reduce the progression of the disease into an advanced stage. 

Weight loss remains the mainstay in NAFLD treatment. 

It can be carried out in the following steps-

1. Obesity assessment
2. Intense weight loss intervention phase
3. Weight loss maintenance intervention phase
4. Weight gain-regain prevention

Various possible therapeutic approaches for weight loss can be tailored based on the patients characteristics, which may include diet, exercise, anti-obesity medications, and endoscopic and surgical bariatric procedures.

Satisfactory results in weight reduction can be achieved by Medications and bariatric interventions, benefitting in the NAFLD activity score and fibrosis.  But they need to be further evaluated in standardized and well-designed randomized-controlled clinical trials to determine their exact efficacy.

Highlights of the review-

• Interventions causing ≥ 5 to 10% weight loss also shows substantial improvement in nonalcoholic fatty liver disease activity (NAFLD) scores (NAS) and NAFLD fibrosis scores (NFS) and even complete NAFLD resolution.
• NAS and NFS scores can be improved with Antiobesity medications, particuarly liraglutide, semaglutide, and orlistat.
• Bariatric endoscopy and surgery have shown supremacy for sustainable weight loss, significant improvement in NAS and fibrosis scores and higher odds for NAFLD resolution.

Source: Semin Liver Dis 2021; 41(04): 435-447. DOI: 10.1055/s-0041-1731704