Treatment and prevention of NAFLD

In the wake of the diabetes pandemic, prevalence of non-alcoholic fatty liver disease (NAFLD) is on the rise. Following his first module about the epidemiology, pathophysiology and diagnosis of NAFLD, Professor Michael Roden’s new module looks at potential treatments for this serious but reversible condition.

The need for therapies to combat NAFLD is clear. Between 70 and 80% of people with type 2 diabetes also have NAFLD. Having diabetes also increases the risk of NAFLD’s progression to other, more severe forms of liver disease. But what therapeutic options are currently available to help prevent NAFLD and its progression in people with diabetes?

The first line of attack, as Professor Roden points out, is lifestyle intervention. “Lifestyle modification can be very efficient,” he says, “not only to prevent but also to treat people with NAFLD. In general, it depends on the amount of weight loss you achieve during an intervention, be it diet only, or diet plus exercise and other strategies. But it requires a significant and relevant amount of weight loss and definitely more than 10% of weight loss is necessary to completely revert fatty liver.”

There are caveats however. “These studies have also shown that only about 10% of the patients treated with a weight loss-inducing lifestyle modification are able to maintain this weight loss for a significant amount of time. So, it is not only weight loss per se but the duration of weight loss that is very important, and it is only 10% of people that can maintain the weight loss required to induce remission of NAFLD.”

What about intensive exercise? “Exercise, particularly when combined with dietary modification, can improve transaminases and have a certain effect on NAFLD. But, there is no study that has clearly shown that exercise alone can revert particularly progressive NAFLD.”

More promising are the sort of intensive, very low-calorie weight loss dietary interventions such as that used in the DiRECT trial. As well as the much-publicised high rates of remission of type 2 diabetes in this trial, results showed reductions in the amount of liver fat – for many, down to normal values. For significant numbers of participants, that ‘NAFLD-free’ status endured over the two-year follow-up. Still, though, as Professor Roden points out, many were unable to sustain the benefits over time. “That again points to the importance of any intervention to maintain weight loss for a relevant duration of time in order to induce diabetes remission and remission of NAFLD. And this is also why a number of groups over the last few years have tried to study a number of drugs in order to treat people with NAFLD and type 2 diabetes.”

To learn more about those efforts and the current state of play in this increasingly significant field, enroll on Professor Roden’s new module, ‘NAFLD –  prevention and treatment’ (available from Wednesday 29th September).

Continuous professional development (CPD) accreditation
We are delighted to announce that Professor Roden’s first module in this course, ‘NAFLD – epidemiology, pathophysiology and diagnosis’ is now the first of our modules to gain CPD accreditation from the UK’s Royal College of General Practitioners.