Weight loss and diet

In overweight patients, weight loss of 7 to 10% of body weight improves histological features of fibrosis and nonalcoholic steatohepatitis; greater weight loss results in greater benefit. Controlled weight loss is encouraged—aim for 7 to 10% body weight loss in the first 12 months. There is no clear evidence to support a particular type of low-calorie diet for weight loss in people with nonalcoholic fatty liver disease (NAFLD). The Mediterranean-style diet improves nonalcoholic fatty liver disease and reduces cardiovascular risk, even in the absence of significant weight loss.

Information on weight loss is available elsewhere in these guidelines, in the context of cardiovascular disease risk modification and lifestyle management for adults with type 2 diabetes. In patients with type 2 diabetes who require drug therapy, it may be appropriate to select an antihyperglycaemic drug that can assist weight loss—see choice of antihyperglycaemic treatment for adults with type 2 diabetes.

Consider referring the patient to an accredited practising dietitian or a weight loss clinic.

If weight loss is not achieved with appropriate lifestyle modification, bariatric surgery should be considered in morbidly obese patients (body mass index [BMI] more than 40 kg/m²) and obese patients with metabolic comorbidities (BMI more than 35 kg/m² and significant comorbidity including type 2 diabetes, ischaemic heart disease or obstructive sleep apnoea).

Observational data suggest that coffee drinking appears to be associated with a small degree of protection against the development of nonalcoholic fatty liver disease, and may be beneficial for patients with existing disease. The benefit appears to be proportional to the amount of coffee consumed, and is independent of the type of coffee drink.