With the improvement of people’s quality of life and the change of lifestyle, obesity has become a topic of concern nowadays. Obesity is often accompanied by fatty liver. There are two most common types of fatty liver: alcoholic fatty liver, which is related to heavy alcohol consumption; and non-alcoholic fatty liver, which is related to obesity, diabetes, hyperlipidemia and other metabolic abnormalities. Patients with fatty liver usually have no specific symptoms, and many are found during routine physical examinations. Some people with fatty liver have normal transaminases, but most patients have elevated transaminases. Different types of fatty liver differ in the timing and indications for treatment. Alcoholic fatty liver: immediate intervention and treatment is required In the initial stage of fatty liver caused by alcohol, transaminases are only slightly elevated and ultrasound shows typical signs of fatty liver. However, if no intervention is made, it will progress to alcoholic hepatitis and then to alcoholic cirrhosis. Therefore, once alcoholic fatty liver is diagnosed, it should be treated immediately. The most important treatment measure is to stop drinking. The word “abstinence” is easy to say, but the actual treatment process is more complicated and can be recurrent. In addition, long-term heavy drinkers must pay attention to the prevention and control of withdrawal syndrome. Patients should be given relevant nutritional support while abstaining from alcohol, such as choosing a high-protein, low-fat diet and supplementing with vitamins B, C, and E as well as folic acid. Most patients with alcoholic fatty liver (without alcoholic hepatitis or alcoholic cirrhosis) can return to normal liver function after abstinence, but a few patients still have abnormal transaminases after abstinence, and the latter are treated medically. Polyenyl phosphatidylcholine can reduce the tendency of liver fibrosis progression, adenosylmethionine can improve the transaminase index, and glycopyrrolate preparations, silymarin, reduced glutathione, and polyenyl phosphatidylcholine can improve the transaminase status to varying degrees. However, do not use multiple drugs at the same time to avoid aggravating the burden on the liver or causing adverse reactions due to drug interactions. Non-alcoholic fatty liver: improve lifestyle first Non-alcoholic fatty liver refers to a type of fatty liver associated with insulin resistance, genetics, and metabolic abnormalities. Once patients are diagnosed with NAFLD, the incidence of cirrhosis in 10-15 years is as high as 15-25%. Patients who are over 50 years old, obese (especially abdominal obesity), have hypertension, type 2 diabetes, other liver diseases, long-term use of drugs that can cause liver damage, long-term alcohol consumption, hyperlipidemia, and insulin resistance have a higher risk of progression to cirrhosis. Insulin resistance refers to the decrease in insulin sensitivity in peripheral organs, which results in a decrease in insulin’s ability to degrade blood glucose and consequently an increase in blood glucose. Insulin resistance is not only the basis of the pathogenesis of type 2 diabetes, but also the common pathophysiological basis of many metabolism-related diseases. Patients with NAFLD should first change their lifestyles and control their weight. Reduce calorie intake, adjust diet structure, adopt a low-sugar, low-fat, high dietary fiber diet, and try not to drink sugary drinks. Adhere to a moderate amount of aerobic exercise more than 4 times a week for a total of 150 minutes or more. It is important to note that weight loss should not exceed 1.6 kg per week, as too rapid weight loss can also lead to increased liver disease. The disease can be reversed in some early stage patients through lifestyle changes and weight control. Medication: Seize the time and monitor closely People who have taken lifestyle changes and weight control for 6-12 months and still have not improved their NAFLD and have lost less than 5% of their body weight should consider medication. For patients with insulin resistance, the insulin sensitizer metformin can be given. For those with hyperlipidemia, such as significantly elevated HDL, triglycerides and cholesterol, lipid-lowering drugs should be added. However, attention should be paid to the hepatotoxicity of drugs and drug-drug interactions. Some lipid-lowering drugs may lead to abnormal liver function and cause drug-related liver injury. Therefore, monthly review and close monitoring of liver function is required during the medication period. Once transaminases are found to be higher than before, the use of lipid-lowering drugs needs to be suspended. Liver-protective and anti-inflammatory drugs can be used as adjuvant medications, but their role in the prevention and treatment of fatty liver remains controversial. Drugs such as polyenophosphatidylcholine, glycopyrrolate preparations, silymarin, reduced glutathione, vitamin E and adenosylmethionine can be used depending on the condition and the duration of treatment is 6 to 12 months. Polyenylphosphatidylcholine is chemically consistent with important endogenous phospholipids. It binds to liver cell and organelle membranes as an intact molecule to repair the damaged membrane structure, thus restoring normal liver function and enzyme activity. Glycyrrhetinic acid preparation is a chemical extracted from licorice (triterpene saponin) that enhances the detoxification capacity of the liver, slows down the process of hepatocyte degeneration and necrosis, and reduces inflammation. Silymarin is extracted from the seed coat of the seeds of silymarin, a medicinal plant of the Asteraceae family, which protects liver cells from toxic substances, especially alcohol and environmental pollutants (pesticides, heavy metals, etc.). It has strong antioxidant function, which can protect liver cells from free radical damage and promote damaged liver cells to repair themselves. Reduced glutathione is an important antioxidant, which can scavenge free radicals in the body and protect the sulfhydryl groups in many molecules such as proteins and enzymes from being oxidized by free radicals and other harmful substances in the body, thus allowing proteins and enzymes etc. to perform their physiological functions and protect the liver function.