Non-Alcoholic Fatty Liver Managment

Non-alcoholic fatty liver disease (NAFLD) is a common liver condition marked by fat accumulation in the liver without significant alcohol consumption. It ranges from benign non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), a more severe form involving inflammation and cell damage, which can progress to fibrosis, cirrhosis, and liver cancer. NAFLD is closely linked to metabolic syndrome, with key risk factors including obesity, type 2 diabetes, insulin resistance, dyslipidaemia, and sedentary lifestyle. Its pathophysiology involves increased free fatty acid delivery to the liver, insulin resistance, oxidative stress, and inflammation leading to liver damage and fibrosis. Diagnosis typically requires imaging or liver biopsy, while treatment focuses on lifestyle modifications such as weight loss and exercise. Pharmacological options include orlistat, pioglitazone, vitamin E, GLP-1 receptor agonists (e.g., semaglutide), and emerging agents like obeticholic acid and resmetirom. While these treatments can reduce liver fat and inflammation, only resmetirom has shown strong Phase III results for fibrosis improvement. Despite promising therapies, lifestyle change remains the cornerstone of NAFLD management.