Non-alcoholic fatty liver disease: What has changed in the treatment since the beginning?

Abstract

Non-alcoholic fatty liver disease (NAFLD) is an umbrella term to describe the entire spectrum of this common liver disease. In patients with NAFLD, especially those with non-alcoholic steatohepatitis (NASH), most often have one or more components of the metabolic syndrome, but this is not universal. Although most patients with NAFLD share many clinical features, only a subset of patients develops significant liver inflammation and progressive fibrosis. On the other hand, not all patients with NASH exhibit insulin resistance. NASH can be seen in patients who are lean and have no identifiable risk factors. Many clinical studies have tried numerous drugs and alternative medicine, however, investigators have failed to identify a safe and effective therapy for patients with NASH. As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.

Role of pentoxifylline in non-alcoholic fatty liver disease in high-fat diet-induced obesity in mice

“…NAFLD is frequently associated with metabolic syndrome establishment and it occurs more often in males than in females and primarily affects the middle aged and the elderly [1] . Several factors are associated with the development of fatty liver, and NAFLD diagnosis requires the exclusion of secondary etiologies, including alcohol consumption, drug usage, hepatitis B and C [2] . Although simple steatosis is considered benign, NASH can progress to end-stage liver disease, such as fibrosis, cirrhosis and hepatic cancer [3] .…”

Comparative effectiveness of diet alone and diet plus metformin treatment on omentin levels in type 2 diabetes patients with nonalcoholic fatty liver disease: a prospective randomized trial

“…At present guidelines, metformin is not recommended as a primary treatment especially from the standpoint of nonalcoholic steatohepatitis (33). We can also say that it can be used in diabetic patients with NAFLD for other indications as recommended previously (34). Furthermore, the interactions of insulin sensitizers and NAFLD with omentin levels must be answered by further study.…”

Glycosyltransferases and non-alcoholic fatty liver disease

“…Various studies have shown that of the patients scheduled for NAFLD treatment, only 15% achieved weight loss, but regained weight with time [22] . Although there is no approved drug therapy for NAFLD, many approaches appear to be beneficial, such as the use of insulin sensitizers, antioxidants and anti-inflammatory agents, and these seem to have promising effects in some patients [23,24] .…”