Evidence-graded answer
Does GLP-1 help with fatty liver (NAFLD/NASH)?
Yes. Multiple GLP-1 trials show liver-fat reduction and improvement in fibrosis markers. Tirzepatide (SYNERGY-NASH, NEJM 2024) achieved NASH resolution without worsening fibrosis in 44-62% of patients vs 10% placebo across the 5/10/15 mg dose arms. Semaglutide has similar but slightly smaller effect.
SYNERGY-NASH: 190 adults with MASH and stage 2-3 fibrosis randomized to tirzepatide 5/10/15 mg vs placebo for 52 weeks. NASH resolution rates: 44%, 56%, 62% vs 10%.
Resmetirom (Rezdiffra, approved March 2024) is the first FDA-approved MASH-specific drug. GLP-1 is not yet FDA-approved for MASH but is widely used off-label in patients with concurrent obesity or T2D.
The benefit appears mediated mostly by weight loss + insulin sensitization; the magnitude tracks closely with total weight loss in trials.
Source: SYNERGY-NASH NEJM 2024, NEJM