Management of Lean Patients with NAFLD (MASLD)

• Lean nonalcoholic fatty liver disease (NAFLD) can progress to clinically significant liver disease without becoming obese.
• Lean NAFLD patients have an improper lifestyle with more sedentary hours and higher dietary intake of free sugars and fructose. Exercise improves insulin resistance in these patients.
• A healthy diet with curtailed free sugars is advised. It is difficult to recommend specific calorie restrictions in this group due to the scarcity of data.
• Weight loss is the central pillar of NAFLD management in general, however, lean patients have normal body mass index (BMI). They need a lesser degree of weight loss to attain NAFLD remission compared to obese patients.
• Indications for pharmacotherapy in lean NAFLD (MASLD) is likely similar to nonlean ones. Drugs like vitamin E, pioglitazone and saroglitazar can be used.