Doctors from multiple specialties have created new guidelines to help treat metabolic hepatic steatosis, a condition where fat builds up in the liver. This disease can lead to serious problems like cirrhosis and liver cancer if not managed properly. The guidelines recommend using simple blood tests and ultrasound scans to catch the disease early, especially in people with type 2 diabetes. They also suggest that eating a Mediterranean diet, exercising regularly, and certain new medications can help reverse liver damage. The key message is that treating this disease works best when different types of doctors work together as a team.

The Quick Take

  • What they studied: How doctors should best diagnose and treat fatty liver disease (metabolic hepatic steatosis) by combining expert opinions and existing research
  • Who participated: Medical experts from different specialties (liver doctors, diabetes specialists, and general doctors) who shared their opinions through a structured voting process called the Delphi method
  • Key finding: Doctors should use simple blood tests and ultrasound scans to find fatty liver disease early, especially in people with diabetes, and should treat it with diet, exercise, and new medications while coordinating care across different medical specialties
  • What it means for you: If you have type 2 diabetes or risk factors for fatty liver disease, ask your doctor about screening. If diagnosed, lifestyle changes like the Mediterranean diet and exercise are proven to help, and new medications may reverse liver damage. Working with a coordinated team of doctors gives you the best chance of improvement.

The Research Details

This is a clinical practice guideline created by bringing together experts from different medical fields (hepatology, endocrinology, internal medicine, and gastroenterology). Rather than conducting a new experiment, the experts reviewed existing research and used a special voting method called the Delphi method to reach agreement on the best practices. In this method, experts vote on recommendations multiple times, seeing how others voted, until they reach strong consensus. This approach combines the knowledge of many experienced doctors to create practical guidance that other doctors can follow in their daily work.

Creating guidelines this way is important because fatty liver disease is complex and affects multiple body systems. No single doctor sees all aspects of the disease, so bringing together experts from different fields ensures the recommendations are comprehensive and practical. The Delphi method helps avoid bias and ensures recommendations are based on strong agreement among experienced professionals rather than just one person’s opinion.

This guideline’s strength comes from the consensus of multiple medical experts across different specialties. The fact that nearly unanimous agreement was reached on key recommendations (like the importance of early prevention and the benefits of diet and exercise) suggests these are well-supported by current evidence. However, as a guideline rather than a new research study, it summarizes existing knowledge rather than presenting new discoveries. The recommendations should be regularly updated as new research emerges.

What the Results Show

The expert panel reached strong agreement that type 2 diabetes is a major risk factor for fatty liver disease and that people with diabetes should be screened early for this condition. They also agreed that simple, non-invasive tests (blood tests called FIB-4 and NFS, and a special ultrasound called FibroScan) should be used to check if the liver has scarring, which helps doctors understand how serious the disease is. The guidelines recommend using these tests in a specific order to make diagnosis more accurate and cost-effective.

The panel reached nearly unanimous agreement that preventing disease progression through early treatment is crucial for improving how patients feel and how long they live. They strongly endorsed the Mediterranean diet (rich in vegetables, fish, and olive oil) and regular physical exercise as effective treatments that can reduce fat in the liver, reduce inflammation, and even reverse some scarring. These lifestyle changes were seen as foundational to treatment.

The guidelines also highlighted that two newer medications—resmiterom and semaglutide—show promise in reversing liver scarring, which is significant because scarring is a sign of advanced disease. However, these medications appear to work best when combined with lifestyle changes rather than as standalone treatments.

A major secondary finding is the importance of coordinated, team-based care. The guidelines emphasize that fatty liver disease affects multiple body systems and requires doctors from different specialties to communicate and work together. Effective referrals between primary care doctors, liver specialists, and diabetes specialists are essential to prevent disease progression. The panel also stressed that having clear protocols for when and how to refer patients between different departments improves patient outcomes.

These guidelines build on and formalize recommendations that have been emerging in recent years. The emphasis on non-invasive testing (rather than liver biopsies) aligns with a shift in modern medicine toward less invasive diagnostic methods. The strong endorsement of Mediterranean diet and exercise reflects growing evidence from multiple studies showing these interventions work. The inclusion of newer medications like semaglutide represents an evolution in treatment options, as these drugs were originally developed for diabetes but have shown benefits for liver health.

As a guideline document, this work summarizes expert opinion and existing research rather than presenting new experimental data. The guidelines don’t specify exact sample sizes or provide new statistical evidence. The recommendations are only as strong as the underlying research they’re based on, and some areas may have limited evidence. Additionally, guidelines are created at a specific point in time and may need updating as new research emerges. Implementation of these guidelines may vary by country and healthcare system, and individual patient circumstances may require modifications to the recommendations.

The Bottom Line

If you have type 2 diabetes or other risk factors, ask your doctor about screening for fatty liver disease using non-invasive tests (HIGH CONFIDENCE). If diagnosed, adopt a Mediterranean diet and increase physical activity as first-line treatment (HIGH CONFIDENCE). Work with a coordinated team of doctors including your primary care physician, a liver specialist, and an endocrinologist (MODERATE-HIGH CONFIDENCE). If lifestyle changes alone aren’t sufficient, discuss newer medications like semaglutide with your doctor (MODERATE CONFIDENCE, as these are newer treatments).

People with type 2 diabetes should definitely pay attention to these guidelines and discuss screening with their doctor. People with obesity, metabolic syndrome, or a family history of liver disease should also consider screening. Healthcare providers across all specialties should use these guidelines to improve how they identify and manage fatty liver disease. People already diagnosed with fatty liver disease will find practical guidance on treatment. However, people without risk factors and with normal liver function may not need immediate action, though maintaining a healthy lifestyle is always beneficial.

Lifestyle changes like diet and exercise can show improvements in liver fat within 8-12 weeks, though more significant improvements in inflammation and scarring may take 3-6 months or longer. Newer medications may show effects within similar timeframes, but individual responses vary. Preventing progression to cirrhosis is a long-term goal requiring sustained effort over years. Regular monitoring with non-invasive tests every 6-12 months helps track progress.

Want to Apply This Research?

  • Track weekly adherence to Mediterranean diet (meals with olive oil, fish, vegetables) and weekly minutes of physical activity. Set a goal of 150 minutes of moderate activity per week. Monitor these metrics alongside periodic liver function test results and FibroScan scores if available.
  • Use the app to log Mediterranean diet meals and exercise sessions. Set reminders for doctor appointments with different specialists (primary care, hepatology, endocrinology). Create a shared care plan that shows referrals between your doctors. Track blood sugar levels if diabetic, as this connects to liver health.
  • Establish a baseline with initial non-invasive testing (blood tests and FibroScan). Track lifestyle metrics weekly through the app. Schedule and log follow-up appointments every 6-12 months. Monitor trends in test results over time. Use the app to facilitate communication between your different doctors by sharing relevant health data and appointment notes.

This guideline summary is for educational purposes and should not replace professional medical advice. Fatty liver disease is a serious condition that requires individualized evaluation and treatment by qualified healthcare providers. If you have risk factors for fatty liver disease or have been diagnosed with this condition, consult with your doctor before making any changes to your diet, exercise routine, or medications. The medications mentioned (resmiterom and semaglutide) require medical supervision and are not appropriate for everyone. Always work with your healthcare team to develop a treatment plan tailored to your specific situation.