Effects of sodium-glucose co-transporter-2 inhibitors on body composition and liver fat markers in non-alcoholic fatty liver disease: a narrative review.

Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder with no definite universal pharmacotherapy. Recent studies have demonstrated that sodium-glucose co-transporter-2 inhibitors (SGLT2i) have the potential to improve body fat composition and hepatic steatosis. This narrative review explores the beneficial effects of SGLT2i on visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat in NAFLD patients. This review identified studies evaluating the effect of SGLT2is on imaging biomarkers (MRI-proton density fat fraction [PDFF%], FibroScan-CAP, liver-to-spleen attenuation ratio) and body fat composition metrics. Among 16 studies assessing VAT, 14 reported significant reductions, attributed to caloric loss and improved insulin sensitivity. Hepatic steatosis, measured with CAP scores, showed a modest decrease (mean difference: -10.59 dB/m vs. controls). Likewise, MRI-PDFF% demonstrated significant absolute reductions ranging from 2.23% to 9.9%. Overall, SGLT2i modestly improve VAT and hepatic steatosis in NAFLD, but their role should complement lifestyle interventions. There is a need for long-term trials to assess histologic endpoints and clinical outcomes.