رجل عمره ٤٥ سنة وزنه ١٠٨ كغ، عنده سكري النوع الثاني وارتفاع دهون، ولا يشرب الكحول. تحاليله أظهرت ارتفاعاً خفيفاً في إنزيمات الكبد، والأشعة الصوتية تظهر كبداً دهنياً. يسأل عن العلاج. ما النصيحة الأهم؟

A 45-year-old man weighing 108 kg with type 2 diabetes and dyslipidaemia, who does not drink alcohol, has mildly raised liver enzymes and a fatty liver on ultrasound. He asks about treatment. What is the most important advice?

1. No change is needed because fatty liver is unimportant
2. Herbal liver supplements instead of diet changes
3. Gradual 7–10% weight loss with exercise and glucose control
4. Total fasting for weeks to cleanse the liver

Answer: C) Gradual 7–10% weight loss with exercise and glucose control. Metabolic fatty liver improves with 7–10% weight loss, exercise and control of glucose and lipids. Very rapid loss can harm, and some herbs are hepatotoxic.