Weight Loss for Patients with Nonalcoholic Fatty Liver Disease

Experts consider steatosis in a person consuming less than 20 to 30 g of alcohol daily (i.e., 1.5 standard alcoholic beverages for women and two standard alcoholic beverages for men) to be a criterion for the diagnosis of nonalcoholic fatty liver disease.1 More than two-thirds of adults who are obese have fatty liver, and 20 percent may have nonalcoholic steatohepatitis.2 More than 90 percent of adults with morbid obesity have fatty liver, and almost one-half have nonalcoholic steatohepatitis.3 According to this Cochrane review, nonalcoholic fatty liver disease has been identified as a cause of cirrhosis, especially cryptogenic cirrhosis. In a 2004 meta-analysis, bariatric surgery was reported to resolve 77 percent of diabetes mellitus cases, 62 percent of hypertension cases, and 70 percent of hyperlipidemia cases.5 Although some experts believe that bariatric surgery may also improve fatty liver disease that accompanies metabolic syndrome, no clinical trials have been performed. [...]there have been some reports of histologic deterioration with rapid weight loss after bariatric surgery, so these patients should be monitored closely.1 Consensus guidelines on nonalcoholic fatty liver disease have been published in the Journal of Digestive Diseases and by the American Gastroenterological Association (AGA).4,6 The AGA recommends that the initial target weight loss be 10 percent of baseline weight at a rate of 1 to 2 lb (0.45 to 0.90 kg) per week.