Hepatic Steatosis: Modern Approaches to Treatment and Management

What is hepatic steatosis and why does it occur?

Hepatic steatosis, also known as non-alcoholic fatty liver disease (NAFLD), is a chronic condition in which excess fat accumulates in liver cells. This condition is one of the most common chronic liver diseases worldwide and is closely associated with metabolic disorders. The main risk factors for the development of NAFLD are obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome [3, 7]. Obesity is a chronic, relapsing, and multifactorial disease, the prevalence of which is constantly growing, creating a significant burden on health and the economy [3, 5]. Since NAFLD is often asymptomatic in the early stages, its diagnosis can be difficult; however, timely detection and treatment are crucial to prevent progression to more serious forms, such as non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and even hepatocellular carcinoma.

The foundation of treatment: lifestyle modification

A key element in the treatment of hepatic steatosis and associated metabolic disorders is lifestyle modification. This includes dietary changes and increased physical activity aimed at achieving and maintaining a healthy weight [3, 5]. Studies show that even moderate weight loss can significantly improve liver health. However, lifestyle changes alone, while associated with minimal risks, are significantly less effective than when combined with pharmacological or surgical treatment methods [3].

• Diet: Particular attention is paid to balanced nutritional approaches. The Mediterranean diet, characterized by a high intake of fruits, vegetables, whole grains, healthy fats (olive oil), and moderate fish consumption, is considered particularly suitable for people with uncomplicated obesity. It promotes gradual and sustainable weight loss, reduces inflammation, and minimizes gastrointestinal side effects [6]. In some cases, for patients with more severe obesity, a very-low-calorie ketogenic therapy (VLEKT) may be considered, which induces nutritional ketosis and may be more effective for rapid weight loss [6].
• Physical activity: Regular physical exercise contributes to weight loss, improved insulin sensitivity, and a reduction in liver fat deposits.

It is important to note that the course of NAFLD is directly dependent on changes in body weight and waist circumference [7].

Pharmacotherapy: new horizons in weight and metabolic management

Modern pharmacotherapy offers new effective approaches to treating obesity and type 2 diabetes mellitus, which are the primary drivers of NAFLD. These drugs not only promote weight loss but also improve metabolic parameters, which indirectly but significantly affects liver health.

• Glucagon-like peptide-1 (GLP-1) receptor agonists: Drugs such as semaglutide, liraglutide, and exenatide are highly effective GLP-1 receptor agonists. They promote significant weight loss and metabolic improvement [5, 6]. Semaglutide, in particular, has shown pronounced weight loss and metabolic improvement [6]. Liraglutide and exenatide are also used in the treatment of diabetic patients with chronic liver disease, and their use is associated with positive changes in weight and waist circumference, which affects the course of NAFLD [7].
• Dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists: Tirzepatide is an example of such a drug, offering a new cardiometabolic strategy that goes beyond simple glycemic control [8]. It provides powerful and sustained weight loss, as well as favorable changes in lipid levels, blood pressure, systemic inflammation, and endothelial function. These effects target the underlying pathophysiological mechanisms of obesity, making it promising for improving liver health [8].
• Other antiglycemic drugs: Metformin and pioglitazone are also used in the treatment of diabetic patients with chronic liver disease. These drugs, along with GLP-1 agonists, contribute to the improvement of laboratory parameters and ultrasound results, especially when combined with proper nursing care [7].

Modern obesity treatment requires a comprehensive approach, including lifestyle modifications, pharmacotherapy, and, in more severe cases, surgical intervention [5].

The role of a comprehensive approach and nursing care

Effective management of hepatic steatosis and comorbid conditions requires an interdisciplinary approach. This means collaboration between doctors of various specialties (gastroenterologists, endocrinologists, nutritionists) and other healthcare professionals. Nursing care plays a special role, which can significantly improve treatment outcomes, especially in patients with diabetes mellitus and chronic liver disease [7]. Nurses help patients adhere to prescribed therapy, monitor changes in weight and waist circumference, and provide necessary information and support for lifestyle changes. Studies have shown that patients who received additional nursing care demonstrated better results compared to those who adhered to therapy on their own [7].

Surgical methods for obesity treatment

For patients with severe obesity, especially in the presence of significant comorbidities, including pronounced hepatic steatosis, bariatric surgery may be the most effective treatment method [3, 5]. Surgical approaches, such as bariatric surgery, provide significant and sustained weight loss, which leads to a substantial improvement in metabolic parameters and, consequently, liver health. Although this is an invasive method, its long-term effectiveness often exceeds other approaches, especially when it comes to significant weight loss and the resolution of comorbidities [3]. The choice between medical and surgical treatment of obesity should be based on individual risk factors, disease severity, the presence of comorbidities, patient preferences, and tolerance to side effects [3].

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4. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. https://pubmed.ncbi.nlm.nih.gov/33315591/
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6. A multidisciplinary perspective on semaglutide treatment and medical nutrition therapy in obesity management. https://pubmed.ncbi.nlm.nih.gov/41129057/
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The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult a specialist for the diagnosis and treatment of diseases.