Hepatic steatosis without overweight or metabolic syndrome

Shira Zelber-Sagi, PhD, RD, is a professor and head of the School of Public Health at the University of Haifa, Israel.

What management should be followed in a patient with hepatic steatosis, a normal body mass index (BMI), and no metabolic syndrome?

This is a very important question because, in fact, some of the patients who we meet in the clinic are not obese and do not have metabolic syndrome, so they don’t need weight reduction as much as obese patients need. However, studies have shown that even minor weight reduction of 3% to 5% of their initial body weight can be beneficial in the lean patient.

It is important to understand that although they have a BMI within the normal range, they might still have abdominal obesity, as indicated by increased waist circumference. When they have weight reduction, they actually reduce their abdominal obesity, which is highly correlated with nonalcoholic fatty liver disease (NAFLD).

Another thing is that these patients should perform physical activity and keep a healthy diet, like the Mediterranean diet, just the same as the obese NAFLD patient.