Non alcoholic fatty liver disease- is it curable?

[DEEPANGSHU]

A 25-year-old female was referred to diabetes outpatient clinic with poorly controlled type 2 diabetes, obesity and elevated LFTs. Her general practitioner had initiated treatment with metformin (1,000 mg twice-daily) and simvastatin (40 mg once-daily), but compliance was limited. Her body weight was 90 kg and her body mass index 32.6 kg/m2. She was asymptomatic and clinical examination, fundus photography, filament testing and albumin/creatinine ratio revealed no signs of complications related to type 2 diabetes. Blood samples showed a glycated hemoglobin A1c (HbA1c) of 8.9% (74 mmol/mol) and a fasting plasma glucose of 7.3 mmol/l. LFTs showed an alanine aminotransferase (ALT) of 196 U/l (reference range 10-45 U/l), an aspartate aminotransferase (AST) of 132 U/l (reference range 15-35 U/l) and an alkaline phosphatase (ALP) of 127 U/l (reference range 35-105 U/l). Lipids were elevated: total cholesterol 4.5 mmol/l, high-density lipoprotein 0.84 mmol/l, low-density lipoprotein 2.4 mmol/l and triglycerides 2.86 mmol/l. Bilirubin, international normalized ratio and albumin were within normal ranges. She had no history of alcohol abuse nor did she take any herbal drug. Abdominal ultrasound revealed increased echogenicity and poor visualization of the intrahepatic vessel walls, suggesting diffuse hepatic steatosis. Is this condition curable?

[DEBDUT]

@deepangshu The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. Losing weight addresses the conditions that contribute to NAFLD. Ideally, a loss of 10% of body weight is desirable, but improvement in risk factors can become apparent if you lose even 3% to 5% of your starting weight. Weight-loss surgery is also an option for those who need to lose a great deal of weight. For those who have cirrhosis due to NASH, liver transplantation may be an option.