Nonalcoholic fatty liver disease in lean subjects: Prognosis, outcomes and management

Table 3 Key elements of management of lean non-alcoholic fatty liver disease

Evaluation of severity of liver	Liver fibrosis (serological markers, elastography, biopsy)
	Presence of NASH (biopsy or serological evidence of inflammation)
Weight reduction	5% of body weight reduction can be effective in reducing steatosis
Physical activity	Positive effect regardless of weight reduction
Dietary Intervention	↓ Fat intake, ↑ protein intake
Commorbidities	Strict control of:
	Diabetes mellitus (consider pioglitazone)
	Hypertriglyceridemia (baseline triglyceride count was independently correlated with NAFLD resolution)
	Hypercholesterolemia (reduction of total cholesterol was independently correlated with steatosis reduction)
	Hypertension
Sleep patterns	Emphasize the significance of adequate sleep duration and quality
Pharmacological therapy	Pioglitazone and vitamin E as the only accepted therapies, but proposed only on an individual basis
	Possible role of probiotics
	Small number of trials for lean patients
	According to the results of trials focusing on non-lean patients

NASH: Non-alcoholic steatohepatitis; NAFLD: Non-alcoholic fatty liver disease.