The trials and tribulations of the treatment of nonalcoholic fatty-liver disease.
OBJECTIVE
To review published clinical trials, with a focus on those of randomized design, of the management of nonalcoholic fatty-liver disease (NAFLD), an increasing complication of the obesity epidemic.


RESULTS
There is increasing recognition that cardiovascular risk issues are associated with NAFLD. Clinical trials of management of NAFLD have focused mainly on hepatic complications. The weight of data point to greatest biochemical and histological benefit with weight-loss measures and thiazolidinediones, but further trials are needed to characterize the benefits and risks of the latter agents. There is currently insufficient trial data to recommend other strategies for treating NAFLD. There is an emerging need for early multiple factor risk intervention, emphasizing cardiometabolic risk and weight management, in addition to minimizing risk of hepatic complications.


CONCLUSIONS
Given the strong association of NAFLD with the metabolic syndrome, early recognition, assessment and management of NAFLD is essential. The management emphasizes weight reduction and attention to cardiometabolic risk factors, similar to recommendations for management of the metabolic syndrome. Future research, guided by increasing knowledge of the pathogenetic factors driving the condition, should clarify the role of other therapies for reducing hepatic and cardiovascular morbidity associated with NAFLD.
Gan
Seng Khee
SK
Metabolic Research Centre, School of Medicine and Pharmacology, Royal Perth Hospital Unit, Australia, University of Western Australia, Perth, Australia. seng.gan@uwa.edu.au
Adams
Leon A
LA
Watts
Gerald F
GF
D000438:Alcohols; D000975:Antioxidants / Q000378:metabolism; D002986:Clinical Trials as Topic; D005234:Fatty Liver / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007328:Insulin / Q000378:metabolism; D015431:Weight Loss / Q000187:drug effects
D000438:Alcohols; D000975:Antioxidants; D007328:Insulin