American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is primarily recommended for patients with nonalcoholic fatty liver disease (NAFLD)?

1. Antiviral medications

2. Weight loss

3. High-protein diet

4. Surgical intervention

The correct answer is: Weight loss

Weight loss is the primary treatment recommended for patients with nonalcoholic fatty liver disease (NAFLD) due to its association with improvements in liver histology and overall health outcomes. This condition is often linked with obesity, insulin resistance, and metabolic syndrome, and weight reduction has been shown to reduce liver fat, inflammation, and fibrosis markers. Research indicates that even modest weight loss of around 5-10% of body weight can lead to significant improvement in liver function and resolution of steatosis (fat accumulation in the liver). This effect is attributed to improvements in insulin sensitivity and reductions in liver fat content. Other treatment modalities, such as antiviral medications, high-protein diets, or surgical interventions, are not first-line recommendations for NAFLD. Antiviral medications are typically indicated for viral hepatitis, high-protein diets may not specifically address the pathophysiology of NAFLD, and surgical options, while potentially beneficial in cases of severe obesity, are usually reserved for selected cases after conventional treatment options have been considered. Therefore, encouraging weight loss is the most effective and evidence-based strategy for managing NAFLD.