Review: Treatment options for nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease comprises a range of disorders from steatosis and steatohepatitis through to cirrhosis. Nonalcoholic steatohepatitis can progress to cirrhosis and liver-related death. Therefore, managing this common disorder is becoming an important public health issue. Lifestyle measures are commonly suggested but robust data are lacking. Trials with antioxidants (vitamin E, betaine) as well as cytoprotectants (ursodeoxycholic acid) have been disappointing. While data for insulin sensitizers such as metformin are less conclusive, thiazolidinediones appear promising. However, not all patients respond to thiazolidinediones. Moreover, issues related to weight gain, cardiovascular risk need to be addressed. The use of endocannabinoid antagonists and insulin secretagogues are novel strategies to combat this disorder.

Double-blind Randomized Placebo-controlled Clinical Trial of Omega 3 Fatty Acids for the Treatment of Diabetic Patients With Nonalcoholic Steatohepatitis

“…Even though the number of patients who showed improvement in overall histology was similar between the PUFA and placebo groups, it is interesting that the mean NAS improved in the placebo group but not in the PUFA. Improvement of patients in the placebo arm in this study is consistent with previous reports in randomized controlled studies on non diabetic patients with NASH that spontaneous improvement in liver histology occurs in 15-26% (7;19). These observations also suggest that PUFA might adversely affect NASH patients with DM.…”

“…The exclusion criteria were (1) cirrhosis defined on liver biopsy or unequivocal clinical evidence of cirrhosis, (2) daily alcohol intake > 30 g for male and > 20 g for females for at least three consecutive months during the previous 5 years assessed by the Skinner lifetime history questionnaire and the self-administered Audit , (3) end stage organ disease associated with diabetes (renal failure defined as a serum creatinine >2, severe neuropathy, advanced peripheral vascular disease), (4) heart failure (NYHA class 2-4), (5) the use of any amount of fish oil supplements during the 6 months prior to biopsy, (6) the use of medications known to cause steatosis, (7) the use of medications that have shown benefits in previous studies (vitamin E, thiazolidinedione, S-adenosylmethione) (8) other types of liver disease suspected by history, clinical finding or serum biochemistries.…”

Nateglinide for Diabetic Patients with Liver Cirrhosis

“…It has been reported that nateglinide can be safely used because it causes no hepatotoxicity (9). It has also been reported that insulin resistance is improved by nateglinide through the upregulated hepatic peroxisome proliferators activated receptor-α and adiponectin receptor R2 mRNA expressions (18). It has been shown that there is no change of the pharmacokinetics of nateglinide when administering this drug to patients with liver cirrhosis (10,19).…”

Kombucha tea prevents obese mice from developing hepatic steatosis and liver damage

“…Pharmacological agents have been studied and developed to improve and prevent NAFLD from progressing into chronic stage liver disease (4). Although these medications have been shown to improve liver function and attenuate insulin resistance in patients with NAFLD, they also induce a high incidence of gastrointestinal side effects (4,5). Therefore, dietary supplements with no side effects are needed to prevent NAFLD.…”