Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH): treatment.
Non-alcoholic fatty liver disease is now recognized as a cause of potentially progressive liver damage, posing patients at risk of advanced liver failure. Unfortunately, the natural history of disease is only partly known, the disease is slowly progressive and therapeutic outcomes are difficult to define. These factors have limited therapeutic trials to pilot studies, and very few randomized-controlled studies are available. The concept that insulin-resistance, coupled with oxidative stress, may be the underlying mechanism responsible for fat accumulation and disease progression points to insulin-sensitizing agents (metformin, thiazolidinediones) as the most promising drugs. They proved effective in reducing enzyme levels in the short period, but very limited information is available on liver histology, not to say progression to liver cell failure. Large, long-term, placebo-controlled randomized studies are eagerly awaited. Outside controlled studies, nutritional counselling and physical exercise aimed at moderate weight loss remain the basis of any therapeutic intervention.
Bugianesi
Elisabetta
E
Department of Gastroenterology, San Giovanni Battista Hospital, University of Turin, Corso Bramante 88, I-10127 Turin, Italy. ebugianesi@yahoo.it
Marzocchi
Rebecca
R
Villanova
Nicola
N
Marchesini
Giulio
G
D000975:Antioxidants / Q000494:pharmacology / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000494:pharmacology / Q000627:therapeutic use; D019610:Cytoprotection; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D005234:Fatty Liver / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D007783:Lactones / Q000494:pharmacology / Q000627:therapeutic use; D008019:Life Style; D008049:Lipase / Q000037:antagonists & inhibitors; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use; D000077403:Orlistat; D018962:Phlebotomy; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000494:pharmacology / Q000627:therapeutic use
D000975:Antioxidants; D002756:Cholagogues and Choleretics; D004791:Enzyme Inhibitors; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007783:Lactones; D045162:Thiazolidinediones; D014580:Ursodeoxycholic Acid; D008687:Metformin; D000077403:Orlistat; D008049:Lipase