Comparative efficacy of interventions on nonalcoholic fatty liver disease (NAFLD)

Sawangjit, Ratree; Chongmelaxme, Bunchai; Phisalprapa, Pochamana; Saokaew, Surasak; Thakkinstian, Ammarin; Kowdley, Kris V.; Chaiyakunapruk, Nathorn

doi:10.1097/md.0000000000004529

Cited by 58 publications

(50 citation statements)

References 82 publications

(238 reference statements)

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“…A network meta-analysis found that pentoxyphylline and OCA improve fibrosis, and vitamin E, TZDs, and OCA improve ballooning degeneration in patients with NASH[ 243 ]. A subsequent network meta-analysis substantially confirmed these findings by showing that OCA significantly improves fibrosis, while vitamin E and TZDs result in a significant increase in NASH resolution[ 244 ]. Table 2 compares the findings from the above two meta-analytic studies[ 243 , 244 ].…”

Section: Nafld: Principles Of Treatmentmentioning

confidence: 92%

Nonalcoholic fatty liver disease: Evolving paradigms

Lonardo¹,

Nascimbeni²,

Maurantonio³

et al. 2017

WJG

165

115

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In the last years new evidence has accumulated on nonalcoholic fatty liver disease (NAFLD) challenging the paradigms that had been holding the scene over the previous 30 years. NAFLD has such an epidemic prevalence as to make it impossible to screen general population looking for NAFLD cases. Conversely, focusing on those cohorts of individuals exposed to the highest risk of NAFLD could be a more rational approach. NAFLD, which can be diagnosed with either non-invasive strategies or through liver biopsy, is a pathogenically complex and clinically heterogeneous disease. The existence of metabolic as opposed to genetic-associated disease, notably including ”lean NAFLD” has recently been recognized. Moreover, NAFLD is a systemic condition, featuring metabolic, cardiovascular and (hepatic/extra-hepatic) cancer risk. Among the clinico-laboratory features of NAFLD we discuss hyperuricemia, insulin resistance, atherosclerosis, gallstones, psoriasis and selected endocrine derangements. NAFLD is a precursor of type 2 diabetes (T2D) and metabolic syndrome and progressive liver disease develops in T2D patients in whom the course of disease is worsened by NAFLD. Finally, lifestyle changes and drug treatment options to be implemented in the individual patient are also critically discussed. In conclusion, this review emphasizes the new concepts on clinical and pathogenic heterogeneity of NAFLD, a systemic disorder with a multifactorial pathogenesis and protean clinical manifestations. It is highly prevalent in certain cohorts of individuals who are thus potentially amenable to selective screening strategies, intensive follow-up schedules for early identification of liver-related and extrahepatic complications and in whom earlier and more aggressive treatment schedules should be carried out whenever possible.

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Section: Nafld: Principles Of Treatmentmentioning

confidence: 92%

Nonalcoholic fatty liver disease: Evolving paradigms

Lonardo¹,

Nascimbeni²,

Maurantonio³

et al. 2017

WJG

165

115

View full text Add to dashboard Cite

show abstract

“…Most pharmacologic treatments for NAFLD are designed to improve insulin sensitivity (eg, metformin, thiazolidinediones liraglutide and sitagliptin), reduce oxidative stress (vitamin E, ursodeoxycholic acid and pentoxifylline) or downregulate fibrosis mechanisms (angiotensin receptor blockers) . Unfortunately, these medications have not demonstrated consistent improvement in liver fibrosis . Alternatively, data are accumulating on the potential role of therapies that alter gut microbiota in the treatment of patients with NAFLD and NASH.…”

Section: Treatments For Nafld That Target Gut Microbiotamentioning

confidence: 99%

Review article: emerging role of the gut microbiome in the progression of nonalcoholic fatty liver disease and potential therapeutic implications

Jayakumar

Loomba

2019

Aliment Pharmacol Ther

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Summary Background Nonalcoholic fatty liver disease (NAFLD) is a prevalent disorder associated with obesity and diabetes. Few treatment options are effective for patients with NAFLD, but connections between the gut microbiome and NAFLD and NAFLD‐associated conditions suggest that modulation of the gut microbiota could be a novel therapeutic option. Aim To examine the effect of the gut microbiota on pathophysiologic causes of NAFLD and assess the potential of microbiota‐targeting therapies for NAFLD. Methods A PubMed search of the literature was performed; relevant articles were included. Results The composition of bacteria in the gastrointestinal tract can enhance fat deposition, modulate energy metabolism and alter inflammatory processes. Emerging evidence suggests a role for the gut microbiome in obesity and metabolic syndrome. NAFLD is often considered the hepatic manifestation of metabolic syndrome, and there has been tremendous progress in understanding the association of gut microbiome composition with NAFLD disease severity. We discuss the role of the gut microbiome in NAFLD pathophysiology and whether the microbiome composition can differentiate the two categories of NAFLD: nonalcoholic fatty liver (NAFL, the non‐progressive form) vs nonalcoholic steatohepatitis (NASH, the progressive form). The association between gut microbiome and fibrosis progression in NAFLD is also discussed. Finally, we review whether modulation of the gut microbiome plays a role in improving treatment outcomes for patients with NAFLD. Conclusions Multiple pathophysiologic pathways connect the gut microbiome with the pathophysiology of NAFLD. Therefore, therapeutics that effectively target the gut microbiome may be beneficial for the treatment of patients with NAFLD.

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“…There have now been several well-designed multi-centre trials in both adults and children examining vitamin E supplementation at pharmacological doses that could not be obtained through diet (107) . Several meta-analyses show benefit from supplemental vitamin E on steatosis, inflammation and ballooning in NASH, although the extent to which vitamin E benefits fibrosis remains unclear (108)(109)(110) . Consequently, UK, EU and US clinical guidelines indicate vitamin E as a therapeutic option once a patient is in second or tertiary care for NASH (1,7,8) , but with the awareness of potential risks for long-term vitamin E supplementation (107) .…”

Section: Supplemental Nutrients: N-3 Pufa Vitamin E and Vitamin Dmentioning

confidence: 99%

From sugar to liver fat and public health: systems biology driven studies in understanding non-alcoholic fatty liver disease pathogenesis

Moore

2019

Proc. Nutr. Soc.

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Non-alcoholic fatty liver disease (NAFLD) is now a major public health concern with an estimated prevalence of 25-30 % of adults in many countries. Strongly associated with obesity and the metabolic syndrome, the pathogenesis of NAFLD is dependent on complex interactions between genetic and environmental factors that are not completely understood. Weight loss through diet and lifestyle modification underpins clinical management; however, the roles of individual dietary nutrients (e.g. saturated and n-3 fatty acids; fructose, vitamin D, vitamin E) in the pathogenesis or treatment of NAFLD are only partially understood. Systems biology offers valuable interdisciplinary methods that are arguably ideal for application to the studying of chronic diseases such as NAFLD, and the roles of nutrition and diet in their molecular pathogenesis. Although present in silico models are incomplete, computational tools are rapidly evolving and human metabolism can now be simulated at the genome scale. This paper will review NAFLD and its pathogenesis, including the roles of genetics and nutrition in the development and progression of disease. In addition, the paper introduces the concept of systems biology and reviews recent work utilising genome-scale metabolic networks and developing multi-scale models of liver metabolism relevant to NAFLD. A future is envisioned where individual genetic, proteomic and metabolomic information can be integrated computationally with clinical data, yielding mechanistic insight into the pathogenesis of chronic diseases such as NAFLD, and informing personalised nutrition and stratified medicine approaches for improving prognosis.

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Comparative efficacy of interventions on nonalcoholic fatty liver disease (NAFLD)

Abstract: Supplemental Digital Content is available in the text

Cited by 58 publications

References 82 publications

Nonalcoholic fatty liver disease: Evolving paradigms

Nonalcoholic fatty liver disease: Evolving paradigms

Review article: emerging role of the gut microbiome in the progression of nonalcoholic fatty liver disease and potential therapeutic implications

From sugar to liver fat and public health: systems biology driven studies in understanding non-alcoholic fatty liver disease pathogenesis

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